CMS Price Transparency Data

Occupational therapy (self-care training)

Facility: Kell West Regional Hospital

Billing Code: 97535 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97535
Insurance Median: $59
Cash Discount Price: $79
vs. Medicare Baseline: 1.82x Medicare

The contracted insurance negotiated median rate for a Occupational therapy (self-care training) at Kell West Regional Hospital is $59. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $79. Compared to the federal Medicare reimbursement reference rate of $32.4, this hospital’s rate is 1.82x the Medicare baseline. Located in 5420 Kell West Boulevard, Wichita Falls, TX.

Cash / Self-Pay

$79

Average discount available for prompt cash payment at this facility.

Insurance Median

$59

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: $79 (244%)

Insurance Median: $59 (182%)

Cash: $79 (244% of Medicare)

Ins. Median: $59 (182% 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
Aetna	$21 - $31	65%
Medicaid / KanCare	$22 - $33	68%
Uhc_Community_Plan	$22 - $33	68%
Blue Cross Blue Shield	$31 - $79	96%
Humana	$31 - $148	96%
Medadv_Uhc	$31	96%
Medicare (plans)	$31	96%
Tricare	$33	102%
Cigna	$35 - $104	108%
Blue_Advantage_Bav	$67	207%
Healthsmart_Ppo	$69 - $104	213%
Blue_Essentials	$71	219%
Phcs	$74 - $111	228%
Self_Pay	$79 - $118	244%
Multiplan	$84 - $126	259%
UnitedHealthcare	$99 - $120	306%

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 $79.
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 Kell West Regional 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.