CMS Price Transparency Data

Occupational therapy (self-care training)

Facility: University of Michigan Health System

Billing Code: 97535 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97535
Insurance Median: $121
Cash Discount Price: $71
vs. Medicare Baseline: 3.73x Medicare

The contracted insurance negotiated median rate for a Occupational therapy (self-care training) at University of Michigan Health System is $121. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $71. Compared to the federal Medicare reimbursement reference rate of $32.4, this hospital’s rate is 3.73x the Medicare baseline. Located in 1500 E Medical Center Drive, Spc 5474, Ann Arbor, MI.

Cash / Self-Pay

$71

Average discount available for prompt cash payment at this facility.

Insurance Median

$121

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: $71 (219%)

Insurance Median: $121 (373%)

Cash: $71 (219% of Medicare)

Ins. Median: $121 (373% 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 373% of the Medicare baseline (a markup of 273%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.

Consult Patient Advocate

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
Point Comfort Underwriters Unaccompanied Children Program	$69 - $86	213%
Priority Health [1038]	$74 - $130	228%
Metrocare	$76 - $94	235%
Medicaid / KanCare	$80 - $100	247%
UnitedHealthcare	$84 - $146	259%
Hap [1023]	$88 - $150	272%
Aetna	$92 - $140	284%
Confinity Advantage	$93 - $115	287%
Blue Care Network Of Michigan	$94	290%
Blue Cross Blue Shield	$94	290%
Plain Church Group	$97 - $120	299%
Beaumont Health Network	$113 - $140	349%
Mclaren Health Plan Inc	$113 - $140	349%
Nomi Health	$113 - $140	349%
Provider Network Of America	$113 - $140	349%
First Agency	$121 - $150	373%
Parkview Health Plan Services	$121 - $150	373%
Cofinity	$123 - $152	380%
Paramount Health Care	$134 - $166	414%
Bronson Healthcare Group	$137 - $170	423%
First Health	$137 - $170	423%
Multiplan	$137 - $170	423%
Priority Health	$171 - $213	528%

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 $71.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 97535.

Insurance In-Network Protection Plan

Contact your insurance company to confirm University of Michigan Health System is fully in-network.
Ask your insurer if "Prior Authorization" is required for CPT code 97535.
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.