CMS Price Transparency Data

Occupational therapy (self-care training)

Facility: Medical City Alliance

Billing Code: 97535 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97535
Insurance Median: $32
Cash Discount Price: $248
vs. Medicare Baseline: 0.99x Medicare

The contracted insurance negotiated median rate for a Occupational therapy (self-care training) at Medical City Alliance is $32. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $248. Compared to the federal Medicare reimbursement reference rate of $32.4, this hospital’s rate is 0.99x the Medicare baseline. Located in 3101 North Tarrant Parkway, Fort Worth, TX.

Cash / Self-Pay

$248

Average discount available for prompt cash payment at this facility.

Insurance Median

$32

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: $248 (765%)

Insurance Median: $32 (99%)

Cash: $248 (765% of Medicare)

Ins. Median: $32 (99% 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
Superior Health Plan	$17 - $34	52%
Amerigroup	$28 - $32	86%
Blue Cross Blue Shield	$28 - $187	86%
Devoted Health	$28 - $32	86%
Humana	$28 - $243	86%
Mutual Of Omaha	$28 - $32	86%
Triwest Veterans	$28 - $32	86%
Wellmed	$28 - $32	86%
Aetna	$29 - $180	90%
Care N Care	$29 - $33	90%
Cigna	$29 - $35	90%
Integranet	$29 - $33	90%
United	$29 - $56	90%
Wellcare	$29 - $33	90%
American Health Plan Of Texas, Inc.	$30 - $34	93%
Procare Advantge	$30 - $34	93%
Provider Partners Health Plan	$30 - $34	93%
Texas Independent Health Plan	$30 - $34	93%
Imperial Insurance Company	$31 - $35	96%
Molina	$31 - $35	96%
Triwest Health Alliance	$32	99%
Verda Health Plan	$37 - $42	114%
Superior	$51 - $72	157%
Oscar	$52	160%
Molina Healthcare	$74 - $84	228%
Healthcare Highways	$84	259%
Multiplan Phcs	$173	534%
Healthsmart Preferred Care	$186	574%
Independent Medical Systems	$248	765%
National Healthcare Solutions	$248	765%

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 $248.
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 Medical City Alliance 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.