CMS Price Transparency Data

Occupational therapy (self-care training)

Facility: Banner Payson Medical Center

Billing Code: 97535 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97535
Insurance Median: $37
Cash Discount Price: $11
vs. Medicare Baseline: 1.14x Medicare

The contracted insurance negotiated median rate for a Occupational therapy (self-care training) at Banner Payson Medical Center is $37. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $11. Compared to the federal Medicare reimbursement reference rate of $32.4, this hospital’s rate is 1.14x the Medicare baseline. Located in 807 South Ponderosa Drive, Payson, AZ.

Cash / Self-Pay

$11

Average discount available for prompt cash payment at this facility.

Insurance Median

$37

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: $11 (34%)

Insurance Median: $37 (114%)

Cash: $11 (34% of Medicare)

Ins. Median: $37 (114% 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
Arizona Physicians Ipa	$20 - $34	62%
Health Net	$20 - $50	62%
Mercy Care	$20 - $34	62%
Aetna	$34 - $81	105%
Banner Health	$34	105%
Banner University Health Plan	$34	105%
Blue Cross Blue Shield	$34 - $172	105%
Care 1St	$34	105%
Cigna	$34 - $66	105%
Gila River Health Care Corporation	$34	105%
Health Choice Arizona, Inc.	$34 - $49	105%
Kaiser Foundation Health Plan	$34	105%
Triwest Healthcare Alliance Corp - Va Ccn	$34	105%
UnitedHealthcare	$34 - $56	105%
Upmc Health Plan	$34	105%
Wellpoint	$34	105%
Carelon	$36	111%
Humana	$36	111%
Arizona Priority Care	$37	114%
Devoted Health Services	$37	114%
Gold Kidney Health Plan	$37	114%
National Healthcare Solutions Inc (Nhsi) And Vip Universal Medical Insurance Group (Vumi)	$37	114%
Plotkin Health	$37	114%
Oscar Health Plan	$56	173%
Quiktrip Corporation	$58	179%
Arizona Medical Network	$75	231%
Provider Network Of America	$75	231%

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 $11.
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 Banner Payson 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.