CMS Price Transparency Data

Occupational therapy (therapeutic activities)

Facility: Munson Healthcare Otsego Memorial Hospital

Billing Code: 97530 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97530
Insurance Median: $50
Cash Discount Price: $115
vs. Medicare Baseline: 1.43x Medicare

The contracted insurance negotiated median rate for a Occupational therapy (therapeutic activities) at Munson Healthcare Otsego Memorial Hospital is $50. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $115. Compared to the federal Medicare reimbursement reference rate of $35.07, this hospital’s rate is 1.43x the Medicare baseline. Located in 825 N Center Ave, Gaylord, MI.

Cash / Self-Pay

$115

Average discount available for prompt cash payment at this facility.

Insurance Median

$50

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: $115 (328%)

Insurance Median: $50 (143%)

Cash: $115 (328% of Medicare)

Ins. Median: $50 (143% 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 - $84	48%
Mclaren Health Plan	$17 - $113	48%
Meridian	$17	48%
Molina	$17 - $36	48%
Priority Health	$17 - $93	48%
UnitedHealthcare	$17 - $108	48%
Blue Care Network	$33	94%
Hap (Health Alliance Plan)	$33 - $108	94%
Humana	$33	94%
Medicare (plans)	$33	94%
Michigan Amish Medical Board	$33	94%
Northern Michigan Mennonite Group	$33	94%
Aetna	$34 - $109	97%
K12 Virtual Schools	$35	100%
Asr Physicians Care Network	$50 - $108	143%
Nomi Health	$53 - $108	151%
Employee Benefit Logistics	$57	163%
Hospice Of Michigan	$81	231%
Cigna	$85 - $93	242%
Munson Hospice	$94 - $852	268%
Enterprise Group Planning/Employee Benefit Plan	$108	308%
Cofinity	$115	328%
Provider Network Of America/Hawaii Mainland Administrative Group Health	$115	328%
Three Rivers Provider Network	$115	328%

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 $115.
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 Munson Healthcare Otsego Memorial 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.