CMS Price Transparency Data

Occupational therapy (self-care training)

Facility: Prisma Health Greer Memorial Hospital

Billing Code: 97535 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97535
Insurance Median: $45
Cash Discount Price: $124
vs. Medicare Baseline: 1.39x Medicare

The contracted insurance negotiated median rate for a Occupational therapy (self-care training) at Prisma Health Greer Memorial Hospital is $45. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $124. Compared to the federal Medicare reimbursement reference rate of $32.4, this hospital’s rate is 1.39x the Medicare baseline. Located in 1413 John B White Sr Blvd Suite D, Spartanburg, SC.

Cash / Self-Pay

$124

Average discount available for prompt cash payment at this facility.

Insurance Median

$45

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: $124 (383%)

Insurance Median: $45 (139%)

Cash: $124 (383% of Medicare)

Ins. Median: $45 (139% 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 Choice Healthplan Of Sc	$16 - $20	49%
Bluechoice Healthplan Of Sc	$17 - $107	52%
Medicaid / KanCare	$17 - $22	52%
Molina	$17 - $34	52%
Select Health	$17 - $33	52%
Humana	$18 - $30	56%
Tricare	$30 - $31	93%
Medicare (plans)	$31 - $57	96%
Veterans Administration	$31	96%
Blue Cross Blue Shield	$32 - $102	99%
Choicecare Network	$32 - $162	99%
Cigna	$32 - $174	99%
Liberty Advantage	$32	99%
UnitedHealthcare	$32 - $33	99%
Absolute Total Care Prime	$33	102%
Aetna	$33 - $167	102%
Windsor Health Plan	$33	102%
Sc Workers Compensation	$43	133%
Wellpath Select Inc	$43	133%
Prisma Health Seniorcare Pace-Upstate	$46	142%
Celtic Insurance Company	$54	167%
Value Options	$95	293%
Promise Health Plan	$114	352%
Preferred Care, Inc	$133	410%
Chp Direct Supermed Network	$137	423%
Medcost	$141	435%
Atlantic Packaging	$142	438%
Aps Healthcare Bethesda Inc	$152	469%
Medcost Preferred	$156	481%
Multiplan	$169	522%
Companion Benefit Alternatives	$190	586%
Miscellaneous	$190	586%
Self Pay	$190	586%

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 $124.
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 Prisma Health Greer 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.