CMS Price Transparency Data

Occupational therapy (self-care training)

Facility: Hillcrest Hospital Pryor

Billing Code: 97535 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97535
Insurance Median: $60
Cash Discount Price: $28
vs. Medicare Baseline: 1.85x Medicare

The contracted insurance negotiated median rate for a Occupational therapy (self-care training) at Hillcrest Hospital Pryor is $60. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $28. Compared to the federal Medicare reimbursement reference rate of $32.4, this hospital’s rate is 1.85x the Medicare baseline. Located in 111 North Bailey Street, Pryor, OK.

Cash / Self-Pay

$28

Average discount available for prompt cash payment at this facility.

Insurance Median

$60

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: $28 (86%)

Insurance Median: $60 (185%)

Cash: $28 (86% of Medicare)

Ins. Median: $60 (185% 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
Black Lung [6055]	$23	71%
Healthcare Highways [2210]	$23 - $60	71%
Hooray Health [8000]	$23	71%
Lucent Health [6000]	$23	71%
Oncology Patient Assistance Programs [2295]	$23	71%
Oscar Insurance Company [7005]	$23	71%
Osma Health Network [2345]	$23	71%
Healthscope Benefits [2290]	$28	86%
UnitedHealthcare	$28	86%
The Kempton Group Administrators [2905]	$42	130%
Beacon Health Options Behavioral Health [2890]	$58	179%
Global Health [1430]	$58	179%
Resource One Administrators [2815]	$60	185%
Universal Fidelity [2085]	$60	185%
Web Tpa [2115]	$60	185%
First Health [1375]	$69	213%
Medica [2910]	$69	213%
Multiplan [1680]	$69	213%
Cigna	$77	238%
Healthpartners [1500]	$77	238%
Pba [1775]	$77	238%
Pending Ssi [1616]	$93	287%

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 $28.
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 Hillcrest Hospital Pryor 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.