CMS Price Transparency Data

Occupational therapy (self-care training)

Facility: Baylor Scott & White Medical Center Hillcrest

Billing Code: 97535 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97535
Insurance Median: $139
Cash Discount Price: $131
vs. Medicare Baseline: 4.29x Medicare

The contracted insurance negotiated median rate for a Occupational therapy (self-care training) at Baylor Scott & White Medical Center Hillcrest is $139. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $131. Compared to the federal Medicare reimbursement reference rate of $32.4, this hospital’s rate is 4.29x the Medicare baseline. Located in 100 Hillcrest Medical Blvd, Waco, TX.

Cash / Self-Pay

$131

Average discount available for prompt cash payment at this facility.

Insurance Median

$139

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: $131 (404%)

Insurance Median: $139 (429%)

Cash: $131 (404% of Medicare)

Ins. Median: $139 (429% 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.

Elevated Commercial Rate Alert (Value-Gap)

The negotiated rate at this facility is 429% of the Medicare baseline (a markup of 329%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.

Consult Patient Advocate

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
Superior Health Plan	$26	80%
Texas Workforce Commission	$72	222%
Baylor Scott & White Health Plan	$79 - $93	244%
Blue Cross Blue Shield	$99 - $121	306%
Aetna	$105	324%
Cigna	$112 - $200	346%
Midcoast	$120	370%
Quiktrip	$120	370%
University Of Mary Hardin-Baylor	$126	389%
Independent Medical System	$131	404%
Imagine Health	$137	423%
Curative	$142	438%
Humana	$142 - $153	438%
First Health	$153	472%
Healthsmart	$153 - $164	472%
Private Health Care System	$164	506%
Triwest	$164	506%
UnitedHealthcare	$284 - $438	877%

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 $131.
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 Baylor Scott & White Medical Center Hillcrest 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.