CMS Price Transparency Data

Occupational therapy (self-care training)

Facility: PAM Health Rehabilitation Hospital of Sugar Land LLC

Billing Code: 97535 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97535
Insurance Median: $92
Cash Discount Price: $138
vs. Medicare Baseline: 2.84x Medicare

The contracted insurance negotiated median rate for a Occupational therapy (self-care training) at PAM Health Rehabilitation Hospital of Sugar Land LLC is $92. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $138. Compared to the federal Medicare reimbursement reference rate of $32.4, this hospital’s rate is 2.84x the Medicare baseline. Located in 7622 Branford Pl, Sugar Land, TX.

Cash / Self-Pay

$138

Average discount available for prompt cash payment at this facility.

Insurance Median

$92

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: $138 (426%)

Insurance Median: $92 (284%)

Cash: $138 (426% of Medicare)

Ins. Median: $92 (284% 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.

Elevated Commercial Rate Alert (Value-Gap)

The negotiated rate at this facility is 284% of the Medicare baseline (a markup of 184%). 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
Aetna	$21 - $31	65%
Curative	$23	71%
Memorial Hermann Health Plan	$25 - $70	77%
Ambetter / Centene	$31	96%
Blue Cross Blue Shield	$31 - $34	96%
Community Health Choice	$31	96%
Ilumed Aco Reach	$31	96%
Molina Healthcare	$31	96%
UnitedHealthcare	$31 - $90	96%
Verda Healthcare	$31	96%
Wellcare Complete	$31	96%
Wellpoint (Amerigroup)	$31	96%
Caresource	$33	102%
Texas Independence Health Plan	$33	102%
Velocity Provider Ppo Network	$37 - $105	114%
Prime Health Services	$40 - $119	123%
Ninety Degree Benefits	$47	145%
Sana Benefits	$47	145%
Cigna	$70 - $115	216%
America'S Choice Provider Network	$94 - $98	290%
Quik Trip	$101 - $105	312%
Usa Managed Care Organization	$101 - $105	312%
Multiplan/Phcs	$108 - $112	333%

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 $138.
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 Health Rehabilitation Hospital of Sugar Land LLC 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.