CMS Price Transparency Data

Occupational therapy (self-care training)

Facility: Ascension Seton Northwest

Billing Code: 97535 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97535
Insurance Median: $31
Cash Discount Price: $69
vs. Medicare Baseline: 0.96x Medicare

The contracted insurance negotiated median rate for a Occupational therapy (self-care training) at Ascension Seton Northwest is $31. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $69. Compared to the federal Medicare reimbursement reference rate of $32.4, this hospital’s rate is 0.96x the Medicare baseline. Located in 11113 Research Boulevard, Austin, TX.

Cash / Self-Pay

$69

Average discount available for prompt cash payment at this facility.

Insurance Median

$31

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: $69 (213%)

Insurance Median: $31 (96%)

Cash: $69 (213% of Medicare)

Ins. Median: $31 (96% 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
Aarp Mc Wellmed	$30	93%
Addr Cancer Together	$31	96%
Aetna	$31 - $157	96%
Covid Hrsa	$31	96%
Cshcn Cidc	$31	96%
Devoted Health Mcr Replacement	$31	96%
Humana	$31	96%
Medicare (plans)	$31	96%
Research Study	$31	96%
Sendero Chap	$31	96%
Smarthealth	$31	96%
Superior Allwell	$31	96%
Tricare	$31 - $35	96%
Wellcare Med Advantage	$31	96%
Connected Senior Care	$32	99%
UnitedHealthcare	$32	99%
Pphp Mcr Advantage	$33	102%
Tx Independence Hp	$33	102%
Champva	$34 - $35	105%
Occunet	$43	133%
Sendero Idealcare	$54	167%
Ambetter / Centene	$56	173%
Blue Cross Blue Shield	$60 - $145	185%
Covenant Health	$154	475%

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 $69.
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 Ascension Seton Northwest 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.