CMS Price Transparency Data

Occupational therapy (therapeutic activities)

Facility: PAM Rehabilitation Hospital of Round Rock

Billing Code: 97530 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97530
Insurance Median: $61
Cash Discount Price: $112
vs. Medicare Baseline: 1.74x Medicare

The contracted insurance negotiated median rate for a Occupational therapy (therapeutic activities) at PAM Rehabilitation Hospital of Round Rock is $61. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $112. Compared to the federal Medicare reimbursement reference rate of $35.07, this hospital’s rate is 1.74x the Medicare baseline. Located in 351 Seton Pkwy, Round Rock, TX.

Cash / Self-Pay

$112

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

$35.07

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $35.07 (100%)

Cash / Self-Pay: $112 (319%)

Insurance Median: $61 (174%)

Cash: $112 (319% of Medicare)

Ins. Median: $61 (174% 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
Curative	$25	71%
Whole Foods (Employers Health Network)	$26	74%
Baylor Scott And White Health Plan	$33	94%
Blue Cross Blue Shield	$33 - $56	94%
Christus Health Plan	$33	94%
Humana	$33 - $169	94%
Ilumed Aco Reach	$33	94%
Sendero Health Plan	$33 - $59	94%
Wellcare Complete	$33	94%
Wellmed	$33	94%
Wellpoint (Amerigroup)	$33	94%
Aetna	$34 - $113	97%
UnitedHealthcare	$34 - $110	97%
Velocity Provider Ppo Network	$40 - $84	114%
Prime Health Services	$44 - $95	125%
Ninety Degree Benefits	$50	143%
Seton Health Plan	$56	160%
Ambetter / Centene	$60	171%
Healthcare Highways	$62	177%
Cigna	$70	200%
Oscar	$75 - $90	214%
Superior Health Plan	$75	214%
America'S Choice Provider	$78	222%
Quik Trip	$84	240%
Usa Managed Care Organization	$84	240%
Multiplan/Phcs	$90	257%
Provider Network Of America	$101	288%

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 $112.
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 PAM Rehabilitation Hospital of Round Rock 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.