CMS Price Transparency Data

Occupational therapy (self-care training)

Facility: Baylor Scott & White Medical Center Pflugerville

Billing Code: 97535 (CPT)

The BaseRate · fair price medium confidence

A fair price for this

$113

about 3.5× the $32 Medicare rate · typically $34–$128

modeled estimate · not a bill or quote

What this hospital charges insurers

$103

About the fair price

about $10 under the fair price · 3.2× Medicare

Medicare pays $32 Fair price $113 This hospital $103 Cash price $147 Hospital's list price $245

How we calculate the fair BaseRate →

How this hospital compares to other TX hospitals

Highest price of the 9 TX hospitals we have prices for — worth calling around.

Cheapest $21 Priciest $103

Black dot = this hospital, among the 9 TX hospitals with a price for this procedure. Full list below.

A fair price for a Occupational therapy (self-care training) is about $113 (about 3.5× the $32 Medicare rate). Baylor Scott & White Medical Center Pflugerville charges insurers about $103, or about $147 in cash — about the fair price. Located in Pflugerville, TX.

What each insurance company pays

Which insurers have negotiated a price with this hospital for this procedure — and which haven’t.

5 of 6 major insurers have a published price at this hospital

✓ UnitedHealthcare✓ Blue Cross Blue Shield✓ Aetna✓ Cigna✓ Humana Kaiser Permanente

Crossed out = this hospital hasn’t published a negotiated price for that insurer for this procedure. It doesn’t necessarily mean they aren’t accepted — ask your insurer.

Insurance company	Price range	vs. Medicare
UnitedHealthcaremajor	$109 - $169	336%
Blue Cross Blue Shieldmajor	$99 - $121	306%
Aetnamajor	$105	324%
Cignamajor	$116 - $200	358%
Humanamajor	$159 - $171	491%
Baylor Scott & White	$89 - $105	275%
+ 6 smaller / regional plans	$135 - $183

Government programs also on file: Medicaid, Military & VA.

Excludes 3 rental-network / third-party entries (e.g. Multiplan, PHCS) — these are pricing networks, not insurers.

Self-Pay How to get the cash price

Tell the billing desk you want to be billed as self-pay — not through insurance — before your visit.
Ask for the cash / prompt-pay discount in writing, with the exact price (about 147), before you agree to anything.
Get it in writing that they won’t also bill your insurance, so the cash price is what you owe.
Check the CPT code on your bill matches exactly: 97535.

Insurance Before you use insurance

Call your insurance company to confirm Baylor Scott & White Medical Center Pflugerville is in-network.
Ask your insurer whether prior approval is required for CPT code 97535.
Confirm the doctor or provider is in-network too — not just the hospital building.
Check your Explanation of Benefits against the hospital’s final itemized bill.

Estimate your out-of-pocket cost

A rough estimate of what you’d pay with insurance (deductible + coinsurance) versus paying the cash price yourself.

How you’d pay

Deductible left to meet ($)

Your coinsurance (%)

Enter your details and press estimate to compare.

Other Procedures at Baylor Scott & White Medical Center Pflugerville

Compare: Occupational therapy (self-care training) at other TX hospitals

Insurance negotiated median for the same procedure, sorted lowest first.