CMS Price Transparency Data

Occupational therapy (therapeutic activities)

Facility: Ascension Providence Hospital, Southfield and Novi

Billing Code: 97530 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97530
Insurance Median: $33
Cash Discount Price: $60
vs. Medicare Baseline: 0.94x Medicare

The contracted insurance negotiated median rate for a Occupational therapy (therapeutic activities) at Ascension Providence Hospital, Southfield and Novi is $33. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $60. Compared to the federal Medicare reimbursement reference rate of $35.07, this hospital’s rate is 0.94x the Medicare baseline. Located in 16001 W Nine Mile Rd, Southfield, MI.

Cash / Self-Pay

$60

Average discount available for prompt cash payment at this facility.

Insurance Median

$33

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$35.07

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $35.07 (100%)

Cash / Self-Pay: $60 (171%)

Insurance Median: $33 (94%)

Cash: $60 (171% of Medicare)

Ins. Median: $33 (94% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $35.07 as the cost baseline. Rates below the baseline represent excellent value. In-network commercial rates commonly hover around 150% - 250% of Medicare, while rates exceeding 300% are elevated. Hover over the green and blue markers to view detailed calculations.

Out-of-Pocket Cost Estimator

Estimate whether it is more economical to use your insurance or pay the upfront self-pay cash rate.

Billing Status

Remaining Deductible ($)

Your Coinsurance Rate (%)

Input your details and click calculate to compare out-of-pocket costs.

Commercial Insurance Negotiated Rates

Negotiated contract ranges established by major commercial carriers at this facility.

Carrier / Plan Group	Contract Rate Range	vs. Medicare Reference
Blue Caid Michigan	$19	54%
Harbor Health Mcd	$19	54%
Medicaid / KanCare	$19 - $33	54%
Molina Health	$19	54%
Total Health Care	$19	54%
UnitedHealthcare	$19	54%
Amerihealth Vip Care Mcr	$28 - $33	80%
Aetna	$29 - $33	83%
Auto Insurance	$33	94%
Humana	$33	94%
Jvhl - Mcr Replacement	$33	94%
Mcr Replacement	$33	94%
Veterans Choice	$33	94%
Meridian Wellcare	$35	100%
Molina Advantage	$35	100%
Hap Alliance Health	$37	106%
Hap Hmo Pos	$37	106%
Ambetter / Centene	$41	117%
Molina Marketplace	$41	117%
Hap Preferred	$44	125%
Smart Health	$45	128%
Bc Metro Detroit Epo	$52	148%
Bc Metro Detroit Hmo	$52	148%
Bcn Local Network Southeast	$52	148%
Blue Care Network	$52	148%
Blue Cross Blue Shield	$52	148%

Self-Pay Upfront Cash Action Plan

Request a "Self-Pay classification" with the billing desk before receiving care.
Ask for a written "Prompt-Pay Discount" agreement quoting the price of $60.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 97530.

Insurance In-Network Protection Plan

Contact your insurance company to confirm Ascension Providence Hospital, Southfield and Novi is fully in-network.
Ask your insurer if "Prior Authorization" is required for CPT code 97530.
Confirm the specific physician or imaging center is also in-network (not just the hospital building).
Audit your Explanation of Benefits (EOB) against the final itemized hospital invoice.