CMS Price Transparency Data

Occupational therapy (self-care training)

Facility: Carolinas Medical Center-Northeast

Billing Code: 97535 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97535
Insurance Median: $74
Cash Discount Price: $82
vs. Medicare Baseline: 2.28x Medicare

The contracted insurance negotiated median rate for a Occupational therapy (self-care training) at Carolinas Medical Center-Northeast is $74. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $82. Compared to the federal Medicare reimbursement reference rate of $32.4, this hospital’s rate is 2.28x the Medicare baseline. Located in 920 Church St N, Concord, NC.

Cash / Self-Pay

$82

Average discount available for prompt cash payment at this facility.

Insurance Median

$74

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: $82 (253%)

Insurance Median: $74 (228%)

Cash: $82 (253% of Medicare)

Ins. Median: $74 (228% 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 228% of the Medicare baseline (a markup of 128%). 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
Alliance	$20 - $21	62%
Amerihealth Caritas	$20	62%
Carolina Complete Health	$20	62%
Healthy Blue	$20	62%
Wellcare	$20	62%
Partners	$21	65%
Trillium	$21	65%
UnitedHealthcare	$21 - $72	65%
Vaya	$21	65%
Cigna	$31 - $131	96%
Humana	$31	96%
Aetna	$32 - $100	99%
Ortho Carolina	$38	117%
Blue Cross Blue Shield	$44 - $59	136%
Ambetter / Centene	$47 - $59	145%
Employers Health Network	$72	222%
Physician Reach Out	$82	253%
Medcost	$88 - $122	272%
Magellan	$98	302%
Gmmi	$106	327%
Quik Trip	$106	327%
Carolina Behavioral Health	$118 - $131	364%
Healthgram	$131	404%
Private Health Care Systems	$131	404%
Choicecare	$134	414%
Lifesynch Community Choice Care	$134	414%
First Health	$139	429%
Beechstreet	$147	454%
Multiplan	$155	478%

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 $82.
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 Carolinas Medical Center-Northeast 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.