CMS Price Transparency Data

Occupational therapy (therapeutic activities)

Facility: Matagorda Regional Medical Center

Billing Code: 97530 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97530
Insurance Median: $75
Cash Discount Price: $56
vs. Medicare Baseline: 2.14x Medicare

The contracted insurance negotiated median rate for a Occupational therapy (therapeutic activities) at Matagorda Regional Medical Center is $75. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $56. Compared to the federal Medicare reimbursement reference rate of $35.07, this hospital’s rate is 2.14x the Medicare baseline. Located in 104 7Th Street, Bay City, TX.

Cash / Self-Pay

$56

Average discount available for prompt cash payment at this facility.

Insurance Median

$75

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: $56 (160%)

Insurance Median: $75 (214%)

Cash: $56 (160% of Medicare)

Ins. Median: $75 (214% 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.

Elevated Commercial Rate Alert (Value-Gap)

The negotiated rate at this facility is 214% of the Medicare baseline (a markup of 114%). 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
Comm Care	$60 - $64	171%
Medicaid / KanCare	$60 - $64	171%
Molina	$60 - $64	171%
Scott & White	$60 - $64	171%
Superior	$60 - $64	171%
Tcstar	$60 - $64	171%
UnitedHealthcare	$60 - $79	171%
Wellpoint	$60 - $64	171%
Aetna	$68 - $71	194%
Humana	$70 - $74	200%
Coventry First Health	$76 - $80	217%
Galaxy Health	$76 - $80	217%
Cigna	$81 - $86	231%
Independent Medical System	$92 - $97	262%
Multiplan Phcs	$92 - $97	262%
Three Rivers	$92 - $97	262%
Health Smart	$97 - $103	277%
Usa Managed	$97 - $103	277%
Blue Cross Blue Shield	$109 - $132	311%

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 $56.
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 Matagorda Regional Medical Center 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.