CMS Price Transparency Data

Occupational therapy (therapeutic activities)

Facility: Hill Country Memorial Hospital

Billing Code: 97530 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97530
Insurance Median: $35
Cash Discount Price: $531
vs. Medicare Baseline: 1.00x Medicare

The contracted insurance negotiated median rate for a Occupational therapy (therapeutic activities) at Hill Country Memorial Hospital is $35. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $531. Compared to the federal Medicare reimbursement reference rate of $35.07, this hospital’s rate is 1.00x the Medicare baseline. Located in 1020 South State Highway 16, Fredericksburg, TX.

Cash / Self-Pay

$531

Average discount available for prompt cash payment at this facility.

Insurance Median

$35

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: $531 (1514%)

Insurance Median: $35 (100%)

Cash: $531 (1514% of Medicare)

Ins. Median: $35 (100% 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
Superior Health	$27 - $36	77%
Wellmed	$28 - $32	80%
Aetna	$30 - $265	86%
Blue Cross Blue Shield	$30 - $157	86%
Gonzaba Medical Group	$30 - $34	86%
Ilumed	$30 - $34	86%
Triwest	$30 - $34	86%
United	$31 - $239	88%
Wellcare	$31 - $35	88%
Triwest Health Alliance	$34	97%
Molina Healthcare	$48 - $54	137%
Superior	$48 - $55	137%
Community First Health Plans	$64 - $143	182%
Healthsmart Preferred Care	$292	833%
Multiplan	$398 - $451	1135%

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 $531.
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 Hill Country Memorial Hospital 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.