CMS Price Transparency Data

Occupational therapy (therapeutic activities)

Facility: Caromont Regional Medical Center

Billing Code: 97530 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97530
Insurance Median: $43
Cash Discount Price: $154
vs. Medicare Baseline: 1.23x Medicare

The contracted insurance negotiated median rate for a Occupational therapy (therapeutic activities) at Caromont Regional Medical Center is $43. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $154. Compared to the federal Medicare reimbursement reference rate of $35.07, this hospital’s rate is 1.23x the Medicare baseline. Located in 2525 Court Dr, Gastonia, NC.

Cash / Self-Pay

$154

Average discount available for prompt cash payment at this facility.

Insurance Median

$43

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: $154 (439%)

Insurance Median: $43 (123%)

Cash: $154 (439% of Medicare)

Ins. Median: $43 (123% 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
Blue Cross Blue Shield	$23 - $41	66%
Carolina Complete Health	$23	66%
Partners Behavioral Health	$23	66%
Alliance Behavioral Health	$24	68%
Amerihealth Caritas	$24	68%
Carolina Complete Health Tailored Plans	$24	68%
UnitedHealthcare	$24 - $148	68%
Vaya Behavioral Health	$24	68%
Wellcare	$24	68%
Aetna	$35 - $76	100%
Devoted Health	$35	100%
Healthteam	$35	100%
Longevity Health	$35	100%
Molina	$35 - $43	100%
Humana	$36 - $136	103%
Absolute Total Care	$43	123%
Gaston County Jail	$46	131%
Surgery Plus	$59	168%
Cigna	$63 - $134	180%
Carolina Caring	$84 - $122	240%
Corporate Benefits Service	$90	257%
Medcost	$105	299%
Beech Street	$126	359%
Multiplan	$126	359%
Self Pay	$139	396%
First Health Network	$146	416%

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 $154.
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 Caromont 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.