CMS Price Transparency Data

Occupational therapy (therapeutic activities)

Facility: Covenant Medical Center

Billing Code: 97530 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97530
Insurance Median: $33
Cash Discount Price: $113
vs. Medicare Baseline: 0.94x Medicare

The contracted insurance negotiated median rate for a Occupational therapy (therapeutic activities) at Covenant Medical Center is $33. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $113. Compared to the federal Medicare reimbursement reference rate of $35.07, this hospital’s rate is 0.94x the Medicare baseline. Located in 1447 N Harrison, Saginaw, MI.

Cash / Self-Pay

$113

Average discount available for prompt cash payment at this facility.

Insurance Median

$33

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%)

Cash / Self-Pay: $113 (322%)

Insurance Median: $33 (94%)

Cash: $113 (322% of Medicare)

Ins. Median: $33 (94% 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
Blue Cross Blue Shield	$17 - $46	48%
Healthy Michigan Mclaren	$17 - $33	48%
Healthy Michigan Meridian	$17 - $33	48%
Healthy Michigan Molina	$17 - $33	48%
Healthy Michigan Priority Health	$17 - $33	48%
Health Advantage Mclaren Employee	$18 - $89	51%
Priority Health E	$19 - $74	54%
Physicians Health Plan	$23 - $89	66%
Priority Health	$23 - $89	66%
Aetna	$28 - $118	80%
Mclaren Health Advantage	$29 - $72	83%
Humana	$31 - $121	88%
Meritain Health	$31 - $123	88%
Blue Care Network	$33 - $46	94%
Health Alliance Plan Of Michigan	$33 - $64	94%
Mclaren Advantage	$33	94%
Molina Healthplan	$33	94%
Physicians Health Plan Advantage/Advantage Plus	$33	94%
Multiplan	$37 - $145	106%
Cigna	$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 $113.
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 Covenant Medical Center 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.