CMS Price Transparency Data

Occupational therapy (therapeutic activities)

Facility: Wakemed, Raleigh Campus

Billing Code: 97530 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97530
Insurance Median: $51
Cash Discount Price: $39
vs. Medicare Baseline: 1.45x Medicare

The contracted insurance negotiated median rate for a Occupational therapy (therapeutic activities) at Wakemed, Raleigh Campus is $51. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $39. Compared to the federal Medicare reimbursement reference rate of $35.07, this hospital’s rate is 1.45x the Medicare baseline. Located in 3000 New Bern Ave, Raleigh, NC.

Cash / Self-Pay

$39

Average discount available for prompt cash payment at this facility.

Insurance Median

$51

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: $39 (111%)

Insurance Median: $51 (145%)

Cash: $39 (111% of Medicare)

Ins. Median: $51 (145% 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
Amerihealth	$13 - $23	37%
Carolina Complete	$13 - $23	37%
Wellcare	$13 - $33	37%
Blue Cross Blue Shield	$17 - $65	48%
Cigna	$21 - $66	60%
Ambetter / Centene	$26 - $53	74%
Aetna	$33 - $144	94%
First Health	$34 - $114	97%
Liberty	$34	97%
Pruitt	$34	97%
Alignment	$35	100%
Medcost	$53 - $98	151%
Phcs	$58 - $104	165%
Multiplan	$66 - $117	188%

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 $39.
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 Wakemed, Raleigh Campus 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.