CMS Price Transparency Data

Occupational therapy (self-care training)

Facility: Methodist Celina Medical Center

Billing Code: 97535 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97535
Insurance Median: $51
Cash Discount Price: $112
vs. Medicare Baseline: 1.57x Medicare

The contracted insurance negotiated median rate for a Occupational therapy (self-care training) at Methodist Celina Medical Center is $51. 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 1.57x the Medicare baseline. Located in 1500 S Dallas Parkway, Celina, TX.

Cash / Self-Pay

$112

Average discount available for prompt cash payment at this facility.

Insurance Median

$51

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: $51 (157%)

Cash: $112 (346% of Medicare)

Ins. Median: $51 (157% 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
Aetna	$33 - $53	102%
Blue Cross Blue Shield	$33 - $159	102%
Mcs Advantage, Inc Classicare [7021]	$33	102%
Medicare (plans)	$33 - $35	102%
UnitedHealthcare	$33 - $35	102%
Ust Health Proof [1005]	$33	102%
Wellcare [7016]	$33	102%
American Health Advantage Of Texas [7099]	$34	105%
Cigna	$34 - $35	105%
Humana	$35	108%
Southwestern Health Resources Swhr [7015]	$35	108%
Oscar Insurance Company [2057]	$42	130%
Molina [3017]	$47	145%
Wellpoint Marketplace Exchange [3071]	$50	154%
Kempton Group Administrators, Tower Extrusions [3061]	$52	160%
90 Degree Benefit [3057]	$54	167%
Allied National [2031]	$54	167%
Entrust/90 Degree [2058]	$54	167%
Department Of Labor [8004]	$65	201%
Evry Health [1013]	$65	201%
Generic Workers Comp Tx Non Par [9010]	$65	201%
Generic Workers Comp Tx Par [8002]	$65	201%
Generic Workers Comp Tx Par [9011]	$65	201%
Sana Benefits [3069]	$65	201%
Velocity [3070]	$65	201%
Health Plans Inc [5017]	$81	250%
Medical Cost Containment Professionals [3059]	$81	250%
Medicaid / KanCare	$169	522%

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 Methodist Celina 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.