CMS Price Transparency Data

Occupational therapy (self-care training)

Facility: The Hospital at Westlake Medical Center

Billing Code: 97535 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97535
Insurance Median: $36
Cash Discount Price: $37
vs. Medicare Baseline: 1.11x Medicare

The contracted insurance negotiated median rate for a Occupational therapy (self-care training) at The Hospital at Westlake Medical Center is $36. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $37. Compared to the federal Medicare reimbursement reference rate of $32.4, this hospital’s rate is 1.11x the Medicare baseline. Located in 5656 Bee Caves Road, Suite M-302, Austin, TX.

Cash / Self-Pay

$37

Average discount available for prompt cash payment at this facility.

Insurance Median

$36

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: $37 (114%)

Insurance Median: $36 (111%)

Cash: $37 (114% of Medicare)

Ins. Median: $36 (111% 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
Blue Cross Blue Shield	$29 - $170	90%
Aetna	$30 - $130	93%
Ambetter / Centene	$33	102%
Edhp	$33	102%
Humana	$33 - $146	102%
Mcr_United	$33	102%
Medicare (plans)	$33	102%
Sendero	$33	102%
Tricare	$33	102%
Triwest	$33	102%
Wellcare	$33	102%
Medicaid / KanCare	$36	111%
90_Degree_Benefits	$50	154%
United_Healthcare	$81 - $105	250%
Superior_Mcd	$101	312%
Cigna	$120	370%
Scott_And_White	$124	383%
Multiplan	$146	451%
Beech_Street	$157	485%

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 $37.
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 The Hospital at Westlake Medical Center 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.