CMS Price Transparency Data

Occupational therapy (self-care training)

Facility: Ascension Providence Rochester Hospital

Billing Code: 97535 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97535
Insurance Median: $31
Cash Discount Price: $47
vs. Medicare Baseline: 0.96x Medicare

The contracted insurance negotiated median rate for a Occupational therapy (self-care training) at Ascension Providence Rochester Hospital is $31. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $47. Compared to the federal Medicare reimbursement reference rate of $32.4, this hospital’s rate is 0.96x the Medicare baseline. Located in 1101 W University Drive, Rochester, MI.

Cash / Self-Pay

$47

Average discount available for prompt cash payment at this facility.

Insurance Median

$31

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: $47 (145%)

Insurance Median: $31 (96%)

Cash: $47 (145% of Medicare)

Ins. Median: $31 (96% 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
Bluecaid	$16	49%
Medicaid / KanCare	$16	49%
Total Health Care Hmo	$16	49%
Aetna	$27	83%
Hap	$27	83%
Smarthealth	$27	83%
Blue Cross Blue Shield	$31 - $55	96%
Hap Senior Plus	$31	96%
Humana	$31	96%
Medicare (plans)	$31 - $32	96%
Priority Health Advantage (Mcr)	$31	96%
- None -	$32	99%
Meridian Health Plan	$38	117%
Blue Care Network	$55	170%
Mva	$58	179%

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 $47.
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 Ascension Providence Rochester 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.