CMS Price Transparency Data

Occupational therapy (self-care training)

Facility: Munson Healthcare Otsego Memorial Hospital

Billing Code: 97535 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97535
Insurance Median: $46
Cash Discount Price: $117
vs. Medicare Baseline: 1.42x Medicare

The contracted insurance negotiated median rate for a Occupational therapy (self-care training) at Munson Healthcare Otsego Memorial Hospital is $46. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $117. Compared to the federal Medicare reimbursement reference rate of $32.4, this hospital’s rate is 1.42x the Medicare baseline. Located in 825 N Center Ave, Gaylord, MI.

Cash / Self-Pay

$117

Average discount available for prompt cash payment at this facility.

Insurance Median

$46

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: $117 (361%)

Insurance Median: $46 (142%)

Cash: $117 (361% of Medicare)

Ins. Median: $46 (142% 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 - $86	49%
Mclaren Health Plan	$16 - $116	49%
Meridian	$16	49%
Molina	$16 - $33	49%
Priority Health	$16 - $85	49%
UnitedHealthcare	$16 - $111	49%
Aetna	$31 - $112	96%
Blue Care Network	$31	96%
Hap (Health Alliance Plan)	$31 - $110	96%
Humana	$31	96%
Medicare (plans)	$31	96%
Michigan Amish Medical Board	$31	96%
Northern Michigan Mennonite Group	$31	96%
Asr Physicians Care Network	$46 - $110	142%
Nomi Health	$50 - $110	154%
Cigna	$51 - $85	157%
Employee Benefit Logistics	$53	164%
Hospice Of Michigan	$83	256%
Munson Hospice	$97 - $852	299%
Enterprise Group Planning/Employee Benefit Plan	$110	340%
Cofinity	$117	361%
Provider Network Of America/Hawaii Mainland Administrative Group Health	$117	361%
Three Rivers Provider Network	$117	361%

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 $117.
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 Munson Healthcare Otsego Memorial Hospital 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.