CMS Price Transparency Data
Occupational therapy (self-care training)
Facility: Trinity Health Oakland Hospital
Billing Code: 97535 (CPT)
Factual Cost Summary (Answer Capsule)
- CPT Billing Code: 97535
- Insurance Median: $105
- Cash Discount Price: $40,328
- vs. Medicare Baseline: 3.24x Medicare
The contracted insurance negotiated median rate for a Occupational therapy (self-care training) at Trinity Health Oakland Hospital is $105. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $40,328. Compared to the federal Medicare reimbursement reference rate of $32.4, this hospital’s rate is 3.24x the Medicare baseline. Located in 44405 Woodward Ave, Pontiac, MI.
Cash / Self-Pay
$40,328
Average discount available for prompt cash payment at this facility.
Insurance Median
$105
Median negotiated contract rate across all mapped commercial carriers.
Medicare Reference Rate
$32.4
Standard federal government reimbursement rate for this code.
Visual Cost Comparison vs. Medicare
Medicare Reference Baseline: $32.4 (100%)
Cash / Self-Pay: $40,328 (124469%)
Insurance Median: $105 (324%)
Cash: $40,328 (124469% of Medicare)
Ins. Median: $105 (324% of Medicare)
Understanding this gauge: We use the federal Medicare rate of $32.4 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.
Elevated Commercial Rate Alert (Value-Gap)
The negotiated rate at this facility is 324% of the Medicare baseline (a markup of 224%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.
Out-of-Pocket Cost Estimator
Estimate whether it is more economical to use your insurance or pay the upfront self-pay cash rate.
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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 Cross Blue Shield | $18 - $17,121 | 56% |
| Medicaid / KanCare | $18 - $9,794 | 56% |
| Aetna | $32 - $17,121 | 99% |
| Align Senior Care | $32 - $17,471 | 99% |
| Blue Care Network Advantage | $32 - $17,121 | 99% |
| Hospice Advantage | $32 - $17,471 | 99% |
| Medicare (plans) | $32 - $17,471 | 99% |
| UnitedHealthcare | $33 - $17,995 | 102% |
| Cca - Zing Health | $34 - $18,491 | 105% |
| Longevity Ipa Of Michigan Llc Health Plan Isnp | $36 - $19,690 | 111% |
| Molina Marketplace | $42 - $22,712 | 130% |
| Wc Accident Fund | $47 | 145% |
| Wc Advantage | $47 | 145% |
| Wc Aig | $47 | 145% |
| Wc Allied | $47 | 145% |
| Wc Amerisure | $47 | 145% |
| Wc Amtrust | $47 | 145% |
| Wc Asu Risk Mgt | $47 | 145% |
| Wc Berkley Admin | $47 | 145% |
| Wc Broadspire | $47 | 145% |
| Wc Bunch & Associates | $47 | 145% |
| Wc Ccmsi | $47 | 145% |
| Wc Emc Insurance Company | $47 | 145% |
| Wc Esis | $47 | 145% |
| Wc Fcci | $47 | 145% |
| Wc Federated | $47 | 145% |
| Wc Gallagher Bassett | $47 | 145% |
| Wc Genex Care For Ohio | $47 | 145% |
| Wc Guard Insurance Company | $47 | 145% |
| Wc Hartford | $47 | 145% |
| Wc Liberty Mutual | $47 | 145% |
| Wc Meijers | $47 | 145% |
| Wc Michigan | $47 | 145% |
| Wc Mitchell Frankenmuth | $47 | 145% |
| Wc Pma | $47 | 145% |
| Wc Sedgwick | $47 | 145% |
| Wc Sentry | $47 | 145% |
| Wc Travelers | $47 | 145% |
| Wc Tristar | $47 | 145% |
| Wc Walmart | $47 | 145% |
| Wc Zurich | $47 | 145% |
| U Of M Health Plan | $49 | 151% |
| Health Cost Solutions | $50 - $27,080 | 154% |
| Vitalcore | $50 - $27,080 | 154% |
| Wellpath | $50 - $27,080 | 154% |
| Bcn Domestic | $55 | 170% |
| Blue Benefit Administrators Of Massachusetts | $55 | 170% |
| Blue Care Network | $55 | 170% |
| Blue Distinction Transplant | $55 | 170% |
| Blue Shield - Ca | $55 | 170% |
| Blue Shield - Id (Regence) | $55 | 170% |
| Blue Shield - Ny Highmark Northeastern | $55 | 170% |
| Blue Shield - Ny Highmark Western | $55 | 170% |
| Blue Shield - Pa (Highmark) | $55 | 170% |
| Blue Shield - Wa (Regence) | $55 | 170% |
| Health Choices | $55 - $114 | 170% |
| Kaiser Domestic | $55 | 170% |
| Priority Health | $61 - $68 | 188% |
| Acs Benefit Services | $68 | 210% |
| Allied Benefit Systems | $68 | 210% |
| Claimchoice Adminstrators | $68 | 210% |
| Consociate | $68 | 210% |
| Cypress Benefit Administrators | $68 | 210% |
| Forest County Potawatomi | $68 | 210% |
| Health Smart | $68 | 210% |
| Healthgram | $68 | 210% |
| Healthscope | $68 | 210% |
| Secureone Preferred United Plans | $68 | 210% |
| Sisco Benefits | $68 | 210% |
| The Health Plan | $68 | 210% |
| Trustmark Small Business Benefits | $68 | 210% |
| Unified Group Services | $68 | 210% |
| Webtpa | $68 | 210% |
| Employee Benefit Logistic | $72 - $40,307 | 222% |
| Mclaren Health | $75 - $81 | 231% |
| Carelon Behavioral Health | $78 | 241% |
| Asr Health Benefits | $80 | 247% |
| Caresource | $80 | 247% |
| Hap | $80 - $113 | 247% |
| Varipro | $80 | 247% |
| Magellan Behavioral Health | $93 | 287% |
| Geha | $97 - $116 | 299% |
| Medical Mutual | $97 | 299% |
| Meritain | $97 | 299% |
| 1199 National Benefit Fund | $105 | 324% |
| Allied National Global Care | $105 | 324% |
| Asrm - Reliance Standard Life Insurance | $105 | 324% |
| Christian Care Ministry | $105 | 324% |
| Dean Health | $105 | 324% |
| Fallon Health | $105 | 324% |
| Family Life Insurance Company | $105 | 324% |
| Ghc Scw | $105 | 324% |
| Group Pension Administrators | $105 | 324% |
| International Benefit Administrators | $105 | 324% |
| Lifetime Benefit Solutions | $105 | 324% |
| Manhattan Life | $105 | 324% |
| Medi Share | $105 | 324% |
| Multiplan | $105 | 324% |
| Mvp | $105 | 324% |
| Pai | $105 | 324% |
| Pan-American Life | $105 | 324% |
| Paramount Hmo | $105 | 324% |
| Phcs | $105 | 324% |
| Trinity Health Share | $105 | 324% |
| Health Partners | $113 | 349% |
| Tufts Health Plan | $113 | 349% |
| Access Health | $114 | 352% |
| Acclaim | $114 | 352% |
| Administrative Concepts | $114 | 352% |
| Allegeant | $114 | 352% |
| Ameriben | $114 | 352% |
| American Family | $114 | 352% |
| American Healthcare Alliance | $114 | 352% |
| American National | $114 | 352% |
| American Republic | $114 | 352% |
| Amerihealth | $114 | 352% |
| Aultcare | $114 | 352% |
| Automated Benefit Services | $114 | 352% |
| Auxiant | $114 | 352% |
| Benefit Administrative Systems,Llc | $114 | 352% |
| Boon Chapman | $114 | 352% |
| Cam Administrative Services | $114 | 352% |
| Christian Brother Services | $114 | 352% |
| Christian Brothers Holy Cross | $114 | 352% |
| Comprehensive Benefits | $114 | 352% |
| Continental Life Insurance | $114 | 352% |
| Custom Benefit Administrators | $114 | 352% |
| Employee Benefit Concepts | $114 | 352% |
| Employee Benefit Management | $114 | 352% |
| Enterprise Group Planning | $114 | 352% |
| Freedom Life Insurance Company | $114 | 352% |
| Group Administrators | $114 | 352% |
| Group Marketing Services | $114 | 352% |
| Guardian | $114 | 352% |
| Health America | $114 | 352% |
| Healthcare Management Admin | $114 | 352% |
| Healthez | $114 | 352% |
| Humana | $114 | 352% |
| Insight | $114 | 352% |
| Intercare | $114 | 352% |
| Jfp Benefit Management | $114 | 352% |
| Jp Farley Corporation | $114 | 352% |
| Key Benefit Administrator | $114 | 352% |
| Liberty Union Life Assurance Co | $114 | 352% |
| Lucent Health | $114 | 352% |
| Luminare Health | $114 | 352% |
| Luminare Health (Detroit) | $114 | 352% |
| Magnacare | $114 | 352% |
| Medben | $114 | 352% |
| Medcost | $114 | 352% |
| Mutual Health Services | $114 | 352% |
| Mutual Of Omaha | $114 | 352% |
| Ncas | $114 | 352% |
| Nippon Life Ins | $114 | 352% |
| Nova | $114 | 352% |
| Painters Union Insurance Fund | $114 | 352% |
| Physicians Mutual | $114 | 352% |
| Plumbers Local 98 Insurance Fund | $114 | 352% |
| Prairie States | $114 | 352% |
| Preferred One | $114 | 352% |
| Primary Physician Care | $114 | 352% |
| Professional Benefit Administrators | $114 | 352% |
| Siho Insurance Services | $114 | 352% |
| The Loomis Company | $114 | 352% |
| Unicare | $114 | 352% |
| Us Health And Life | $114 | 352% |
| Valenz | $114 | 352% |
| Western & Southern Financial Group | $114 | 352% |
| Wps | $114 | 352% |
| Cigna | $115 | 355% |
| Coventry | $117 | 361% |
| First Health | $117 | 361% |
| Prime Health Services | $124 | 383% |
| Three Rivers Provider Network | $140 | 432% |
| Cmh Detroit Wayne Integrated Health Network | $155 | 478% |
| Cmh Lenawee County | $155 | 478% |
| Cmh Livingston County | $155 | 478% |
| Cmh Misc | $155 | 478% |
| Cmh Monroe County | $155 | 478% |
| Cmh Oakland County | $155 | 478% |
| Cmh Washtenaw County | $155 | 478% |