CMS Price Transparency Data

Occupational therapy (therapeutic activities)

Facility: Texas Scottish Rite Hospital for Children

Billing Code: 97530 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97530
Insurance Median: $70
Cash Discount Price: $158
vs. Medicare Baseline: 2.00x Medicare

The contracted insurance negotiated median rate for a Occupational therapy (therapeutic activities) at Texas Scottish Rite Hospital for Children is $70. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $158. Compared to the federal Medicare reimbursement reference rate of $35.07, this hospital’s rate is 2.00x the Medicare baseline. Located in 2222 Welborn Street, Dallas, TX.

Cash / Self-Pay

$158

Average discount available for prompt cash payment at this facility.

Insurance Median

$70

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: $158 (451%)

Insurance Median: $70 (200%)

Cash: $158 (451% of Medicare)

Ins. Median: $70 (200% 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
Tricare	$40	114%
Aetna	$42 - $72	120%
Blue Cross Blue Shield	$70 - $123	200%
Children Med Center Health Plan - All Plans	$70	200%
Community First Health Plan-All Plans	$70	200%
Cook Childrens Hp-All Plans	$70	200%
Driscoll Childrens-All Plans	$70	200%
Medicaid / KanCare	$70	200%
Molina Commercial - All Other Plans	$70	200%
Soonercare-All Plans	$70	200%
UnitedHealthcare	$70 - $103	200%
Firstcare Health Mcaid	$73	208%
Tx Childrens Hlth Mcaid-All Plans	$73	208%
Firstcare Health Comm - All Other Plans	$111	317%
Healthscope - All Plans	$118	336%
Scott & White Comm- All Other Plans	$118	336%
Cigna	$125	356%

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 $158.
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 Texas Scottish Rite Hospital for Children 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.