CMS Price Transparency Data

Occupational therapy (therapeutic activities)

Facility: Methodist McKinney Hospital

Billing Code: 97530 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97530
Insurance Median: $48
Cash Discount Price: $90
vs. Medicare Baseline: 1.37x Medicare

The contracted insurance negotiated median rate for a Occupational therapy (therapeutic activities) at Methodist McKinney Hospital is $48. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $90. Compared to the federal Medicare reimbursement reference rate of $35.07, this hospital’s rate is 1.37x the Medicare baseline. Located in 8000 W Eldorado Pkwy Bldg C Suite C, McKinney, TX.

Cash / Self-Pay

$90

Average discount available for prompt cash payment at this facility.

Insurance Median

$48

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: $90 (257%)

Insurance Median: $48 (137%)

Cash: $90 (257% of Medicare)

Ins. Median: $48 (137% 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
Aetna	$35 - $288	100%
Blue Cross Blue Shield	$35 - $294	100%
Medicare (plans)	$35 - $38	100%
UnitedHealthcare	$35 - $38	100%
Ust Health Proof [1005]	$35	100%
Wellcare [7016]	$35	100%
American Health Advantage Of Texas [7099]	$37	106%
Cigna	$37	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%
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%
Evry Health [1013]	$70	200%
Sana Benefits [3069]	$70	200%
Velocity [3070]	$70	200%
Web Tpa [3049]	$265 - $288	756%

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 $90.
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 McKinney 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.