CMS Price Transparency Data

Occupational therapy (self-care training)

Facility: Novant Health Forsyth Medical Center

Billing Code: 97535 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97535
Insurance Median: $89
Cash Discount Price: $74
vs. Medicare Baseline: 2.75x Medicare

The contracted insurance negotiated median rate for a Occupational therapy (self-care training) at Novant Health Forsyth Medical Center is $89. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $74. Compared to the federal Medicare reimbursement reference rate of $32.4, this hospital’s rate is 2.75x the Medicare baseline. Located in 3333 Silas Creek Parkway, Winston-Salem, NC.

Cash / Self-Pay

$74

Average discount available for prompt cash payment at this facility.

Insurance Median

$89

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: $74 (228%)

Insurance Median: $89 (275%)

Cash: $74 (228% of Medicare)

Ins. Median: $89 (275% 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 275% of the Medicare baseline (a markup of 175%). 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
Carolina Complete	$22 - $37	68%
Nc Department Of Public Safety	$22 - $37	68%
Amerihealth	$23 - $38	71%
Blue Cross Blue Shield	$23 - $143	71%
UnitedHealthcare	$23 - $133	71%
Wellcare	$23 - $38	71%
Cigna	$46 - $77	142%
Caresource North Carolina	$48 - $79	148%
Aetna	$60 - $158	185%
Atlantic Corporation Dba Atlantic Packaging	$67 - $112	207%
Plotkin Health	$71 - $119	219%
Amps	$77 - $129	238%
Humana	$93 - $154	287%
Medcost	$101 - $186	312%
Primary Physician Care	$105 - $174	324%
Beechstreet	$107 - $178	330%
Multiplan	$107 - $178	330%
Phcs	$107 - $178	330%
Employers Choice Network	$115 - $192	355%
Three Rivers Provider Network	$115 - $192	355%

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 $74.
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 Novant Health Forsyth Medical Center 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.