CMS Price Transparency Data

Occupational therapy (self-care training)

Facility: HCA Houston Healthcare Tomball

Billing Code: 97535 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97535
Insurance Median: $33
Cash Discount Price: $240
vs. Medicare Baseline: 1.02x Medicare

The contracted insurance negotiated median rate for a Occupational therapy (self-care training) at HCA Houston Healthcare Tomball is $33. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $240. Compared to the federal Medicare reimbursement reference rate of $32.4, this hospital’s rate is 1.02x the Medicare baseline. Located in 605 Holderrieth, Tomball, TX.

Cash / Self-Pay

$240

Average discount available for prompt cash payment at this facility.

Insurance Median

$33

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: $240 (741%)

Insurance Median: $33 (102%)

Cash: $240 (741% of Medicare)

Ins. Median: $33 (102% 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
Superior Health Plan	$14 - $34	43%
Oscar	$28 - $86	86%
Aetna	$29 - $175	90%
Blue Cross Blue Shield	$29 - $155	90%
Chc Harris Health	$29 - $33	90%
Cigna	$29 - $33	90%
Devoted Health	$29 - $33	90%
Humana	$29 - $331	90%
Integranet Amerigroup Ipa	$29 - $34	90%
Triwest Healthcare Alliance	$29 - $33	90%
United	$29 - $199	90%
Van Lang Ipa	$29 - $33	90%
Wellcare	$29 - $34	90%
Wellmed	$29 - $33	90%
American Health Plan	$30 - $34	93%
Procare Advantage	$30 - $34	93%
Provider Partners Health Plan Of Texas	$30 - $34	93%
Shared Health	$30 - $34	93%
Community Health Choice Mcd	$31 - $57	96%
Molina	$31 - $35	96%
Christus (Usfhp)	$32	99%
Triwest Health Alliance	$32	99%
Verda Health Plan	$37 - $42	114%
Community Health Choice	$42 - $47	130%
Superior	$42 - $50	130%
Molina Healthcare	$62 - $70	191%
Coventry National First Health	$86 - $161	265%

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 $240.
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 HCA Houston Healthcare Tomball 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.