CMS Price Transparency Data
Occupational therapy (self-care training)
Facility: Trinity Health Muskegon Hospital
Billing Code: 97535 (CPT)
Factual Cost Summary (Answer Capsule)
- CPT Billing Code: 97535
- Insurance Median: $101
- Cash Discount Price: $87
- vs. Medicare Baseline: 3.12x Medicare
The contracted insurance negotiated median rate for a Occupational therapy (self-care training) at Trinity Health Muskegon Hospital is $101. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $87. Compared to the federal Medicare reimbursement reference rate of $32.4, this hospital’s rate is 3.12x the Medicare baseline. Located in 1500 E Sherman Blvd, Muskegon, MI.
Cash / Self-Pay
$87
Average discount available for prompt cash payment at this facility.
Insurance Median
$101
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: $87 (269%)
Insurance Median: $101 (312%)
Cash: $87 (269% of Medicare)
Ins. Median: $101 (312% 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 312% of the Medicare baseline (a markup of 212%). 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.
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 Cross Blue Shield | $17 - $65 | 52% |
| Medicaid / KanCare | $17 | 52% |
| Access Health | $22 | 68% |
| Aetna | $30 - $91 | 93% |
| Blue Care Network Advantage | $30 | 93% |
| Medicare (plans) | $30 | 93% |
| Align Senior Care | $31 | 96% |
| Correctional Recovery | $31 | 96% |
| Heartland Hospice | $31 | 96% |
| Hospice Harbor Hospice | $31 | 96% |
| UnitedHealthcare | $32 - $118 | 99% |
| Longevity Ipa Of Michigan Llc Health Plan Isnp | $35 | 108% |
| Molina Marketplace | $40 | 123% |
| Oscar | $40 | 123% |
| Vitalcore | $48 | 148% |
| Wellpath | $48 | 148% |
| U Of M Health Plan | $49 - $106 | 151% |
| Bcn Domestic | $65 | 201% |
| Blue Benefit Administrators Of Massachusetts | $65 | 201% |
| Blue Care Network | $65 | 201% |
| Blue Distinction Transplant | $65 | 201% |
| Blue Shield - Ca | $65 | 201% |
| Blue Shield - Id (Regence) | $65 | 201% |
| Blue Shield - Ny Highmark Northeastern | $65 | 201% |
| Blue Shield - Ny Highmark Western | $65 | 201% |
| Blue Shield - Pa (Highmark) | $65 | 201% |
| Blue Shield - Wa (Regence) | $65 | 201% |
| Health Choices | $65 - $106 | 201% |
| Kaiser Domestic | $65 | 201% |
| Acs Benefit Services | $70 | 216% |
| Allied Benefit Systems | $70 | 216% |
| Claimchoice Adminstrators | $70 | 216% |
| Consociate | $70 | 216% |
| Cypress Benefit Administrators | $70 | 216% |
| Forest County Potawatomi | $70 | 216% |
| Health Smart | $70 | 216% |
| Healthgram | $70 | 216% |
| Healthscope | $70 | 216% |
| Preferred One | $70 | 216% |
| Secureone Preferred United Plans | $70 | 216% |
| Sisco Benefits | $70 | 216% |
| The Health Plan | $70 | 216% |
| Trustmark Small Business Benefits | $70 | 216% |
| Unified Group Services | $70 | 216% |
| Webtpa | $70 | 216% |
| Asr Health Benefits | $71 | 219% |
| Hap | $71 - $106 | 219% |
| Priority Health | $71 - $80 | 219% |
| Wc Accident Fund | $71 | 219% |
| Wc Advantage | $71 | 219% |
| Wc Aig | $71 | 219% |
| Wc Allied | $71 | 219% |
| Wc Amerisure | $71 | 219% |
| Wc Amtrust | $71 | 219% |
| Wc Asu Risk Mgt | $71 | 219% |
| Wc Berkley Admin | $71 | 219% |
| Wc Broadspire | $71 | 219% |
| Wc Bunch & Associates | $71 | 219% |
| Wc Ccmsi | $71 | 219% |
| Wc Emc Insurance Company | $71 | 219% |
| Wc Esis | $71 | 219% |
| Wc Fcci | $71 | 219% |
| Wc Federated | $71 | 219% |
| Wc Gallagher Bassett | $71 | 219% |
| Wc Genex Care For Ohio | $71 | 219% |
| Wc Guard Insurance Company | $71 | 219% |
| Wc Hartford | $71 | 219% |
| Wc Liberty Mutual | $71 | 219% |
| Wc Meijers | $71 | 219% |
| Wc Michigan | $71 | 219% |
| Wc Mitchell Frankenmuth | $71 | 219% |
| Wc Pma | $71 | 219% |
| Wc Sedgwick | $71 | 219% |
| Wc Sentry | $71 | 219% |
| Wc Travelers | $71 | 219% |
| Wc Tristar | $71 | 219% |
| Wc Walmart | $71 | 219% |
| Wc Zurich | $71 | 219% |
| Hospice Of Michigan | $74 | 228% |
| Nomi Health | $75 | 231% |
| Varipro | $78 | 241% |
| Caresource | $84 | 259% |
| Cigna | $84 | 259% |
| Geha | $91 - $118 | 281% |
| Meritain | $91 | 281% |
| 1199 National Benefit Fund | $100 | 309% |
| Allied National Global Care | $100 | 309% |
| Asrm - Reliance Standard Life Insurance | $100 | 309% |
| Christian Care Ministry | $100 | 309% |
| Dean Health | $100 | 309% |
| Fallon Health | $100 | 309% |
| Family Life Insurance Company | $100 | 309% |
| Ghc Scw | $100 | 309% |
| Group Pension Administrators | $100 | 309% |
| International Benefit Administrators | $100 | 309% |
| Lifetime Benefit Solutions | $100 | 309% |
| Manhattan Life | $100 | 309% |
| Medi Share | $100 | 309% |
| Multiplan | $100 | 309% |
| Mvp | $100 | 309% |
| Pai | $100 | 309% |
| Pan-American Life | $100 | 309% |
| Paramount Hmo | $100 | 309% |
| Phcs | $100 | 309% |
| Trinity Health Share | $100 | 309% |
| Acclaim | $106 | 327% |
| Administrative Concepts | $106 | 327% |
| Allegeant | $106 | 327% |
| Ameriben | $106 | 327% |
| American Family | $106 | 327% |
| American Healthcare Alliance | $106 | 327% |
| American Republic | $106 | 327% |
| Amerihealth | $106 | 327% |
| Aultcare | $106 | 327% |
| Automated Benefit Services | $106 | 327% |
| Auxiant | $106 | 327% |
| Benefit Administrative Systems,Llc | $106 | 327% |
| Boon Chapman | $106 | 327% |
| Cam Administrative Services | $106 | 327% |
| Christian Brother Services | $106 | 327% |
| Christian Brothers Holy Cross | $106 | 327% |
| Comprehensive Benefits | $106 | 327% |
| Continental Life Insurance | $106 | 327% |
| Custom Benefit Administrators | $106 | 327% |
| Employee Benefit Concepts | $106 | 327% |
| Employee Benefit Management | $106 | 327% |
| Enterprise Group Planning | $106 | 327% |
| Freedom Life Insurance Company | $106 | 327% |
| Group Administrators | $106 | 327% |
| Group Marketing Services | $106 | 327% |
| Guardian | $106 | 327% |
| Health America | $106 | 327% |
| Healthez | $106 | 327% |
| Humana | $106 | 327% |
| Insight | $106 | 327% |
| Intercare | $106 | 327% |
| Jfp Benefit Management | $106 | 327% |
| Jp Farley Corporation | $106 | 327% |
| Key Benefit Administrator | $106 | 327% |
| Liberty Union Life Assurance Co | $106 | 327% |
| Lucent Health | $106 | 327% |
| Luminare Health | $106 | 327% |
| Luminare Health (Detroit) | $106 | 327% |
| Medben | $106 | 327% |
| Medcost | $106 | 327% |
| Medical Mutual | $106 | 327% |
| Mutual Health Services | $106 | 327% |
| Mutual Of Omaha | $106 | 327% |
| Ncas | $106 | 327% |
| Nippon Life Ins | $106 | 327% |
| Nova | $106 | 327% |
| Painters Union Insurance Fund | $106 | 327% |
| Physicians Mutual | $106 | 327% |
| Plumbers Local 98 Insurance Fund | $106 | 327% |
| Prairie States | $106 | 327% |
| Primary Physician Care | $106 | 327% |
| Professional Benefit Administrators | $106 | 327% |
| The Loomis Company | $106 | 327% |
| Unicare | $106 | 327% |
| Us Health And Life | $106 | 327% |
| Valenz | $106 | 327% |
| Western & Southern Financial Group | $106 | 327% |
| Wps | $106 | 327% |
| First Health | $110 | 340% |
| Barinet | $134 | 414% |
| Cmh Allegan County | $134 | 414% |
| Cmh Barry County | $134 | 414% |
| Cmh Berrien County | $134 | 414% |
| Cmh Cass County | $134 | 414% |
| Cmh Kalamazoo | $134 | 414% |
| Cmh Kent County | $134 | 414% |
| Cmh Misc | $134 | 414% |
| Cmh Muskegon County | $134 | 414% |
| Cmh North Country | $134 | 414% |
| Cmh Northern Lakes County | $134 | 414% |
| Cmh Ottawa County | $134 | 414% |
| Cmh Van Buren County | $134 | 414% |
| Cmh West Mi County | $134 | 414% |