CMS Price Transparency Data

Occupational therapy (self-care training)

Facility: Covenant Medical Center

Billing Code: 97535 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97535
Insurance Median: $32
Cash Discount Price: $102
vs. Medicare Baseline: 0.99x Medicare

The contracted insurance negotiated median rate for a Occupational therapy (self-care training) at Covenant Medical Center is $32. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $102. Compared to the federal Medicare reimbursement reference rate of $32.4, this hospital’s rate is 0.99x the Medicare baseline. Located in 1447 N Harrison, Saginaw, MI.

Cash / Self-Pay

$102

Average discount available for prompt cash payment at this facility.

Insurance Median

$32

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: $102 (315%)

Insurance Median: $32 (99%)

Cash: $102 (315% of Medicare)

Ins. Median: $32 (99% 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.

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
Blue Cross Blue Shield	$16 - $42	49%
Healthy Michigan Mclaren	$16 - $31	49%
Healthy Michigan Meridian	$16 - $31	49%
Healthy Michigan Molina	$16 - $31	49%
Healthy Michigan Priority Health	$16 - $31	49%
Health Advantage Mclaren Employee	$19 - $80	59%
Priority Health E	$19 - $67	59%
Physicians Health Plan	$23 - $80	71%
Priority Health	$23 - $80	71%
Aetna	$28 - $107	86%
Mclaren Health Advantage	$29 - $66	90%
Blue Care Network	$31 - $42	96%
Health Alliance Plan Of Michigan	$31 - $60	96%
Humana	$31 - $110	96%
Mclaren Advantage	$31	96%
Molina Healthplan	$31	96%
Physicians Health Plan Advantage/Advantage Plus	$31	96%
Meritain Health	$32 - $112	99%
Multiplan	$38 - $131	117%
Cigna	$80	247%

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 $102.
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 Covenant Medical Center 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.