CMS Price Transparency Data

Occupational therapy (therapeutic activities)

Facility: Henry Ford Macomb Hospital

Billing Code: 97530 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97530
Insurance Median: $51
Cash Discount Price: Unavailable
vs. Medicare Baseline: 1.45x Medicare

The contracted insurance negotiated median rate for a Occupational therapy (therapeutic activities) at Henry Ford Macomb Hospital is $51. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is unavailable. Compared to the federal Medicare reimbursement reference rate of $35.07, this hospital’s rate is 1.45x the Medicare baseline. Located in 15855 Nineteen Mile Rd, Clinton Township, MI.

Cash / Self-Pay

Unavailable

Average discount available for prompt cash payment at this facility.

Insurance Median

$51

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%)

Insurance Median: $51 (145%)

Ins. Median: $51 (145% 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
Aetna	$19 - $70	54%
Blue Cross Blue Shield	$19 - $57	54%
Hap	$19 - $54	54%
Mclaren	$19	54%
Meridian Health Plan Of Mi	$19	54%
Priority Health	$19 - $84	54%
Molina	$20 - $33	57%
Molina Mi Health Link	$33	94%
Humana	$34 - $46	97%
Wellcare	$35	100%
Cofinity Group Health	$41 - $82	117%
UnitedHealthcare	$56	160%
Vitalcore Physicians Group Of Mi	$56	160%
Mclaren Health	$58	165%
Multiplan, Inc.	$73	208%
Cigna	$89	254%
University Of Michigan	$89	254%

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 $X.
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 Henry Ford Macomb Hospital 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.