CMS Price Transparency Data

Occupational therapy (self-care training)

Facility: PAM Rehabilitation Hospital of Clear Lake

Billing Code: 97535 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97535
Insurance Median: $61
Cash Discount Price: $83
vs. Medicare Baseline: 1.88x Medicare

The contracted insurance negotiated median rate for a Occupational therapy (self-care training) at PAM Rehabilitation Hospital of Clear Lake is $61. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $83. Compared to the federal Medicare reimbursement reference rate of $32.4, this hospital’s rate is 1.88x the Medicare baseline. Located in 110 East Medical Center Boulevard, Webster, TX.

Cash / Self-Pay

$83

Average discount available for prompt cash payment at this facility.

Insurance Median

$61

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$32.4

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $32.4 (100%)

Cash / Self-Pay: $83 (256%)

Insurance Median: $61 (188%)

Cash: $83 (256% of Medicare)

Ins. Median: $61 (188% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $32.4 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	$8 - $21	25%
Wellpoint (Amerigroup)	$21	65%
Curative	$24	74%
Community Health Choice	$32	99%
Christus Health Plan	$33 - $34	102%
Scan Health Plan	$33 - $34	102%
Caresource	$34	105%
Ninety Degree Benefits	$41 - $42	127%
Healthcare Highways	$45 - $47	139%
America'S Choice Provider Network	$57 - $59	176%
Provider Network Of America	$61 - $64	188%
Quik Trip	$61 - $64	188%
Usa Managed Care Organization	$61 - $64	188%
Velocity Provider Ppo Network	$61 - $64	188%
Multiplan/Phcs	$65 - $68	201%
Prime Health Services	$69 - $72	213%
Cigna	$70 - $115	216%
Memorial Hermann Health Plan	$70	216%
Medincrease	$73 - $76	225%
Select Care	$90	278%
Today'S Option	$90	278%

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 $83.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 97535.

Insurance In-Network Protection Plan

Contact your insurance company to confirm PAM Rehabilitation Hospital of Clear Lake is fully in-network.
Ask your insurer if "Prior Authorization" is required for CPT code 97535.
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.