Occupational therapy (therapeutic activities)
Facility: University of Michigan Health System
Billing Code: 97530 (CPT)
- CPT Billing Code: 97530
- Insurance Median: $75
- Cash Discount Price: $74
- vs. Medicare Baseline: 2.14x Medicare
Average discount available for prompt cash payment at this facility.
Median negotiated contract rate across all mapped commercial carriers.
Standard federal government reimbursement rate for this code.
Visual Cost Comparison vs. 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.
Elevated Commercial Rate Alert (Value-Gap)
The negotiated rate at this facility is 214% of the Medicare baseline (a markup of 114%). 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.
Commercial Insurance Negotiated Rates
Negotiated contract ranges established by major commercial carriers at this facility.
| Carrier / Plan Group | Contract Rate Range | vs. Medicare Reference |
|---|---|---|
| Aetna | $23 - $189 | 66% |
| Ambetter / Centene | $23 | 66% |
| Blue Cross Blue Shield | $23 - $102 | 66% |
| Buckeye Community Health Plan | $23 | 66% |
| Hap Midwest | $23 | 66% |
| Mclaren Health Plan Inc | $23 - $172 | 66% |
| Medicaid / KanCare | $23 - $143 | 66% |
| Molina Healthcare Of Michigan Inc | $23 - $30 | 66% |
| Priority Health | $23 - $286 | 66% |
| UnitedHealthcare | $23 - $209 | 66% |
| Amerihealth Michigan Inc | $24 | 68% |
| Huron Valley Pace | $28 | 80% |
| Blue Care Network Of Michigan | $29 - $102 | 83% |
| Health Alliance Plan | $29 | 83% |
| Humana | $29 | 83% |
| Medigold Trinity Health Plan Of Michigan | $29 | 83% |
| Meridian Health Plan Of Michigan Inc | $29 | 83% |
| Paramount Elite-Ohio | $29 | 83% |
| Paramount Health Care | $29 - $237 | 83% |
| Thome Pace | $29 | 83% |
| Triwest | $29 | 83% |
| Veteran Affairs Community Care Program | $29 | 83% |
| Medicare (plans) | $30 | 86% |
| Zing Health | $31 | 88% |
| Point Comfort Underwriters Unaccompanied Children Program | $43 - $123 | 123% |
| Priority Health [1038] | $46 - $192 | 131% |
| Metrocare | $47 - $134 | 134% |
| Employee Benefit Logistic | $50 | 143% |
| Hap [1023] | $55 - $214 | 157% |
| Confinity Advantage | $58 - $189 | 165% |
| Plain Church Group | $60 - $172 | 171% |
| First Health | $65 - $186 | 185% |
| Cofinity | $66 - $189 | 188% |
| Beaumont Health Network | $70 - $200 | 200% |
| Nomi Health | $70 - $200 | 200% |
| Provider Network Of America | $70 - $200 | 200% |
| First Agency | $75 - $214 | 214% |
| Parkview Health Plan Services | $75 - $214 | 214% |
| Bronson Healthcare Group | $85 - $243 | 242% |
| Multiplan | $85 - $243 | 242% |