CMS Price Transparency Data

Occupational therapy (self-care training)

Facility: Cook Childrens Medical Center Prosper

Billing Code: 97535 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97535
Insurance Median: $42
Cash Discount Price: $69
vs. Medicare Baseline: 1.30x Medicare

The contracted insurance negotiated median rate for a Occupational therapy (self-care training) at Cook Childrens Medical Center Prosper is $42. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $69. Compared to the federal Medicare reimbursement reference rate of $32.4, this hospital’s rate is 1.30x the Medicare baseline. Located in 4100 W University Drive, Prosper, TX.

Cash / Self-Pay

$69

Average discount available for prompt cash payment at this facility.

Insurance Median

$42

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: $69 (213%)

Insurance Median: $42 (130%)

Cash: $69 (213% of Medicare)

Ins. Median: $42 (130% 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
Health Plan W. Uhrip	$28 - $35	86%
Health Plan W/O Uhrip	$28 - $50	86%
Superior Health	$31	96%
Wellpoint	$32	99%
Blue Cross Blue Shield	$33 - $83	102%
Aetna	$34 - $78	105%
United Community	$34 - $40	105%
UnitedHealthcare	$41 - $78	127%
Beacon	$42 - $50	130%
El Paso Health First	$42 - $50	130%
Tx Children Health	$42 - $50	130%
Firstcare	$45 - $74	139%
S&W Health	$77	238%
Cigna	$78	241%
Healthscope	$78	241%
Imagine Health	$78	241%
Humana	$80 - $81	247%
Multiplan	$80	247%
First Health	$81	250%
Galaxy Health	$83	256%
Healthsmart	$83	256%
Usamco	$85	262%

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 $69.
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 Cook Childrens Medical Center Prosper 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.