CMS Price Transparency Data

Occupational therapy (self-care training)

Facility: Texas Health Presbyterian Hospital Allen

Billing Code: 97535 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97535
Insurance Median: $111
Cash Discount Price: $112
vs. Medicare Baseline: 3.43x Medicare

The contracted insurance negotiated median rate for a Occupational therapy (self-care training) at Texas Health Presbyterian Hospital Allen is $111. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $112. Compared to the federal Medicare reimbursement reference rate of $32.4, this hospital’s rate is 3.43x the Medicare baseline. Located in 1105 Central Expressway North, Allen, TX.

Cash / Self-Pay

$112

Average discount available for prompt cash payment at this facility.

Insurance Median

$111

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: $112 (346%)

Insurance Median: $111 (343%)

Cash: $112 (346% of Medicare)

Ins. Median: $111 (343% 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 343% of the Medicare baseline (a markup of 243%). 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
Amerigroup	$21 - $33	65%
Blue Cross Blue Shield	$21 - $287	65%
Parkland	$21	65%
UnitedHealthcare	$21 - $401	65%
Molina	$23 - $33	71%
Superior Wellcare	$23 - $35	71%
American Health	$32	99%
Healthspring	$32	99%
Humana	$33	102%
Aetna	$76 - $130	235%
City Of Fort Worth	$87	269%
Fort Worth Firefighters	$114 - $250	352%
Quick Trip	$132	407%
Healthsmart	$140 - $156	432%
Phcs	$156	481%
Multiplan	$162	500%
Galaxy	$164	506%
Usa	$164	506%
Cigna	$175 - $396	540%

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 $112.
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 Texas Health Presbyterian Hospital Allen 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.