CMS Price Transparency Data

Occupational therapy (therapeutic activities)

Facility: Methodist Richardson Medical Center

Billing Code: 97530 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97530
Insurance Median: $46
Cash Discount Price: $112
vs. Medicare Baseline: 1.31x Medicare

The contracted insurance negotiated median rate for a Occupational therapy (therapeutic activities) at Methodist Richardson Medical Center is $46. 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 $35.07, this hospital’s rate is 1.31x the Medicare baseline. Located in 2831 E President George Bush Highway, Richardson, TX.

Cash / Self-Pay

$112

Average discount available for prompt cash payment at this facility.

Insurance Median

$46

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$35.07

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $35.07 (100%)

Cash / Self-Pay: $112 (319%)

Insurance Median: $46 (131%)

Cash: $112 (319% of Medicare)

Ins. Median: $46 (131% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $35.07 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
UnitedHealthcare	$21 - $38	60%
Aetna	$35 - $57	100%
Blue Cross Blue Shield	$35 - $164	100%
Covid19 Hrsa Uninsured Testing And Treatment Fund [6005]	$35	100%
Medicare (plans)	$35 - $38	100%
Ust Health Proof [1005]	$35	100%
Wellcare [7016]	$35	100%
American Health Advantage Of Texas [7099]	$37	106%
Cigna	$37 - $65	106%
Globalhealth [1003]	$37	106%
Humana	$37	106%
Procare Advantage [7018]	$37	106%
Southwestern Health Resources Swhr [7015]	$37	106%
Provider Partners Health Plan [7025]	$39	111%
Coralvita [9216]	$42	120%
Alternative Service Concepts [8005]	$44	125%
Oscar Insurance Company [2057]	$46	131%
Bright Healthcare [2222]	$49	140%
Molina [3017]	$51	145%
Wellpoint Marketplace Exchange [3071]	$55	157%
90 Degree Benefit [3057]	$58	165%
Allied National [2031]	$58	165%
Entrust/90 Degree [2058]	$58	165%
Ambetter / Centene	$60	171%
Friday Health Plan [2061]	$60	171%
Imperial Insurance Companies [3073]	$63	180%
Web Tpa [3049]	$65	185%
Evry Health [1013]	$70	200%
Sana Benefits [3069]	$70	200%
Velocity [3070]	$70	200%
Health Plans Inc [5017]	$88	251%
Medical Cost Containment Professionals [3059]	$88	251%
Medicaid / KanCare	$92	262%
Dart Member Care [3039]	$95	271%
Healthscope Benefits [2052]	$95	271%
Healthscope Benefits [3063]	$95	271%

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: 97530.

Insurance In-Network Protection Plan

Contact your insurance company to confirm Methodist Richardson Medical Center is fully in-network.
Ask your insurer if "Prior Authorization" is required for CPT code 97530.
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.