CMS Price Transparency Data

Occupational therapy (therapeutic activities)

Facility: Texas Health Presbyterian Hospital Rockwall

Billing Code: 97530 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97530
Insurance Median: $118
Cash Discount Price: $117
vs. Medicare Baseline: 3.36x Medicare

The contracted insurance negotiated median rate for a Occupational therapy (therapeutic activities) at Texas Health Presbyterian Hospital Rockwall is $118. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $117. Compared to the federal Medicare reimbursement reference rate of $35.07, this hospital’s rate is 3.36x the Medicare baseline. Located in 3150 Horizon Road, Rockwall, TX.

Cash / Self-Pay

$117

Average discount available for prompt cash payment at this facility.

Insurance Median

$118

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: $117 (334%)

Insurance Median: $118 (336%)

Cash: $117 (334% of Medicare)

Ins. Median: $118 (336% 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.

Elevated Commercial Rate Alert (Value-Gap)

The negotiated rate at this facility is 336% of the Medicare baseline (a markup of 236%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.

Consult Patient Advocate

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
Amerigroup	$19 - $36	54%
Blue Cross Blue Shield	$19 - $334	54%
Parkland	$19	54%
UnitedHealthcare	$19 - $401	54%
Molina	$20 - $36	57%
Superior Wellcare	$20 - $37	57%
American Health	$34	97%
Healthspring	$35	100%
Humana	$35	100%
Aetna	$80 - $137	228%
City Of Fort Worth	$92	262%
Quick Trip	$117 - $123	334%
Fort Worth Firefighters	$120 - $250	342%
Phcs	$136 - $146	388%
Healthsmart	$147 - $164	419%
Multiplan	$170	485%
Galaxy	$172	490%
Usa	$172	490%
Cigna	$184 - $396	525%

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 $117.
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 Health Presbyterian Hospital Rockwall 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.