CMS Price Transparency Data

Occupational therapy (therapeutic activities)

Facility: Medical Center Hospital

Billing Code: 97530 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97530
Insurance Median: $61
Cash Discount Price: $79
vs. Medicare Baseline: 1.74x Medicare

The contracted insurance negotiated median rate for a Occupational therapy (therapeutic activities) at Medical Center Hospital is $61. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $79. Compared to the federal Medicare reimbursement reference rate of $35.07, this hospital’s rate is 1.74x the Medicare baseline. Located in 500 W 4Th Street, Odessa, TX.

Cash / Self-Pay

$79

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: $79 (225%)

Insurance Median: $61 (174%)

Cash: $79 (225% 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
Corvel Wc	$16	46%
Medicaid / KanCare	$17 - $18	48%
Superior Chips	$17	48%
UnitedHealthcare	$19 - $160	54%
Aetna	$33 - $81	94%
Humana	$33	94%
Novitas Solutions	$33	94%
Triwest Va Ccn	$33	94%
Care Improvement Plus	$34	97%
Ambetter / Centene	$35	100%
Wellcare By Allwell	$35	100%
Group Resources	$41	117%
Blue Cross Blue Shield	$53 - $100	151%
Health Select	$53 - $75	151%
90 Degree Benefits	$59 - $109	168%
State Comptroller	$62	177%
Workers Comp	$68	194%
Healthsmart Preferred Care	$74 - $117	211%
Texas Mutual Wc	$81	231%
Caprock	$107 - $126	305%
Firstcare	$110	314%
Geha	$147	419%
Cigna	$218	622%

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 $79.
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 Medical Center 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.