CMS Price Transparency Data

Occupational therapy (therapeutic activities)

Facility: North Carolina Baptist Hospital

Billing Code: 97530 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97530
Insurance Median: $54
Cash Discount Price: $82
vs. Medicare Baseline: 1.54x Medicare

The contracted insurance negotiated median rate for a Occupational therapy (therapeutic activities) at North Carolina Baptist Hospital is $54. 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 $35.07, this hospital’s rate is 1.54x the Medicare baseline. Located in Medical Center Boulevard, Winston-Salem, NC.

Cash / Self-Pay

$82

Average discount available for prompt cash payment at this facility.

Insurance Median

$54

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: $82 (234%)

Insurance Median: $54 (154%)

Cash: $82 (234% of Medicare)

Ins. Median: $54 (154% 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
Medcost	$32 - $112	91%
Aetna	$33 - $144	94%
Apex	$33	94%
Blue Cross Blue Shield	$33 - $57	94%
Cigna	$33 - $187	94%
Devoted	$33	94%
Healthteam	$33	94%
Humana	$33 - $92	94%
Medicare (plans)	$33	94%
UnitedHealthcare	$33 - $58	94%
Wellcare	$33 - $39	94%
Amerihealth	$36 - $46	103%
Carolina Complete	$36 - $38	103%
Health Blue	$36 - $38	103%
Partners	$36 - $38	103%
Alliance	$37 - $39	106%
Trillium	$37 - $39	106%
Vaya	$37 - $39	106%
Liberty	$38	108%
Ambetter / Centene	$43 - $46	123%
Oscar	$48 - $61	137%
Directnet	$95 - $100	271%
Cone Health	$112 - $118	319%
Healthgram	$112 - $118	319%
First Carolina Care	$128 - $135	365%
Private Healthcare Systems	$131 - $139	374%
Multiplan	$144 - $152	411%

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: 97530.

Insurance In-Network Protection Plan

Contact your insurance company to confirm North Carolina Baptist 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.