CMS Price Transparency Data

Occupational therapy (self-care training)

Facility: Carolina East Medical Center

Billing Code: 97535 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97535
Insurance Median: $67
Cash Discount Price: $59
vs. Medicare Baseline: 2.07x Medicare

The contracted insurance negotiated median rate for a Occupational therapy (self-care training) at Carolina East Medical Center is $67. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $59. Compared to the federal Medicare reimbursement reference rate of $32.4, this hospital’s rate is 2.07x the Medicare baseline. Located in 2000 Neuse Blvd, New Bern, NC.

Cash / Self-Pay

$59

Average discount available for prompt cash payment at this facility.

Insurance Median

$67

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: $59 (182%)

Insurance Median: $67 (207%)

Cash: $59 (182% of Medicare)

Ins. Median: $67 (207% 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 207% of the Medicare baseline (a markup of 107%). 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
Pamlico Co Jail-All Plans	$20 - $33	62%
UnitedHealthcare	$26 - $88	80%
Humana	$31	96%
Inclusive Health (Nchirp)-All Plans	$31	96%
Tricare	$31 - $124	96%
Craven Co. Jail Systems - All Plans	$42 - $148	130%
Medcost Ppo Employees And Retirees	$49 - $81	151%
Medcost Ppo Ultra (Employees)	$49 - $78	151%
Blue Cross Blue Shield	$52 - $85	160%
Medcost Ppo City Employees	$54 - $90	167%
Medcost Ppo County Employee	$56 - $94	173%
Benefit Mgmt, Svcs-All Plans	$63 - $105	194%
Medcost Benefit Svc-All Other Plans	$65 - $110	201%
Aetna	$66 - $110	204%
Acs Consult Svc Inc-All Plans	$67 - $112	207%
Cigna	$67 - $113	207%
Medcost Ppo Standard	$67 - $112	207%

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 $59.
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 Carolina East 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.