CMS Price Transparency Data

Occupational therapy (self-care training)

Facility: Baylor Scott and White Medical Center Lake Pointe

Billing Code: 97535 (CPT)

The BaseRate · fair price medium confidence

A fair price for this

$96

about 3.0× the $32 Medicare rate · typically $36–$122

modeled estimate · not a bill or quote

What this hospital charges insurers

$110

About the fair price

about $14 over the fair price · 3.4× Medicare

Medicare pays $32 Fair price $96 This hospital $110 Cash price $115 Hospital's list price $192

How we calculate the fair BaseRate →

How this hospital compares to other TX hospitals

Highest price of the 9 TX hospitals we have prices for — worth calling around.

Cheapest $21 Priciest $110

Black dot = this hospital, among the 9 TX hospitals with a price for this procedure. Full list below.

A fair price for a Occupational therapy (self-care training) is about $96 (about 3.0× the $32 Medicare rate). Baylor Scott and White Medical Center Lake Pointe charges insurers about $110, or about $115 in cash — about the fair price. Located in Rowlett, TX.

What each insurance company pays

Which insurers have negotiated a price with this hospital for this procedure — and which haven’t.

5 of 6 major insurers have a published price at this hospital

✓ UnitedHealthcare✓ Blue Cross Blue Shield✓ Aetna✓ Cigna✓ Humana Kaiser Permanente

Crossed out = this hospital hasn’t published a negotiated price for that insurer for this procedure. It doesn’t necessarily mean they aren’t accepted — ask your insurer.

Insurance company	Price range	vs. Medicare
UnitedHealthcaremajor	$104 - $133	321%
Blue Cross Blue Shieldmajor	$21 - $164	65%
Aetnamajor	$105	324%
Cignamajor	$95 - $202	293%
Humanamajor	$135	417%
Ambetter (Centene)	$125	386%
Baylor Scott & White	$95 - $112	293%
Health Net	$106	327%
+ 5 smaller / regional plans	$106 - $144

Government programs also on file: Medicaid, Military & VA.

Excludes 3 rental-network / third-party entries (e.g. Multiplan, PHCS) — these are pricing networks, not insurers.

Self-Pay How to get the cash price

Tell the billing desk you want to be billed as self-pay — not through insurance — before your visit.
Ask for the cash / prompt-pay discount in writing, with the exact price (about 115), before you agree to anything.
Get it in writing that they won’t also bill your insurance, so the cash price is what you owe.
Check the CPT code on your bill matches exactly: 97535.

Insurance Before you use insurance

Call your insurance company to confirm Baylor Scott and White Medical Center Lake Pointe is in-network.
Ask your insurer whether prior approval is required for CPT code 97535.
Confirm the doctor or provider is in-network too — not just the hospital building.
Check your Explanation of Benefits against the hospital’s final itemized bill.

Estimate your out-of-pocket cost

A rough estimate of what you’d pay with insurance (deductible + coinsurance) versus paying the cash price yourself.

How you’d pay

Deductible left to meet ($)

Your coinsurance (%)

Enter your details and press estimate to compare.

Other Procedures at Baylor Scott and White Medical Center Lake Pointe

Compare: Occupational therapy (self-care training) at other TX hospitals

Insurance negotiated median for the same procedure, sorted lowest first.