CMS Price Transparency Data

Occupational therapy (therapeutic activities)

Facility: Texas Health Presbyterian Hospital Flower Mound

Billing Code: 97530 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97530
Insurance Median: $118
Cash Discount Price: $115
vs. Medicare Baseline: 3.36x Medicare

The contracted insurance negotiated median rate for a Occupational therapy (therapeutic activities) at Texas Health Presbyterian Hospital Flower Mound is $118. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $115. Compared to the federal Medicare reimbursement reference rate of $35.07, this hospital’s rate is 3.36x the Medicare baseline. Located in 4400 Long Prairie Road, Flower Mound, TX.

Cash / Self-Pay

$115

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: $115 (328%)

Insurance Median: $118 (336%)

Cash: $115 (328% 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	$28 - $36	80%
Blue Cross Blue Shield	$28 - $334	80%
Cook Childrens	$28 - $29	80%
UnitedHealthcare	$28 - $401	80%
Superior Wellcare	$30 - $37	86%
Aetna	$31 - $137	88%
Molina	$31 - $36	88%
American Health	$34	97%
Healthspring	$35	100%
Humana	$35	100%
City Of Fort Worth	$88 - $92	251%
Quick Trip	$113 - $123	322%
Fort Worth Firefighters	$115 - $250	328%
Phcs	$131 - $146	374%
Healthsmart	$141 - $164	402%
Multiplan	$164 - $170	468%
Galaxy	$165 - $172	470%
Usa	$165 - $172	470%
Cigna	$177 - $396	505%

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 $115.
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 Flower Mound 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.