CMS Price Transparency Data

Occupational therapy (therapeutic activities)

Facility: Carolina East Medical Center

Billing Code: 97530 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97530
Insurance Median: $71
Cash Discount Price: $67
vs. Medicare Baseline: 2.02x Medicare

The contracted insurance negotiated median rate for a Occupational therapy (therapeutic activities) at Carolina East Medical Center is $71. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $67. Compared to the federal Medicare reimbursement reference rate of $35.07, this hospital’s rate is 2.02x the Medicare baseline. Located in 2000 Neuse Blvd, New Bern, NC.

Cash / Self-Pay

$67

Average discount available for prompt cash payment at this facility.

Insurance Median

$71

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: $67 (191%)

Insurance Median: $71 (202%)

Cash: $67 (191% of Medicare)

Ins. Median: $71 (202% 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.

Elevated Commercial Rate Alert (Value-Gap)

The negotiated rate at this facility is 202% of the Medicare baseline (a markup of 102%). 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	$21 - $38	60%
UnitedHealthcare	$28 - $102	80%
Humana	$34	97%
Inclusive Health (Nchirp)-All Plans	$34	97%
Tricare	$34 - $144	97%
Craven Co. Jail Systems - All Plans	$48 - $49	137%
Medcost Ppo Employees And Retirees	$52 - $95	148%
Medcost Ppo Ultra (Employees)	$52 - $90	148%
Blue Cross Blue Shield	$55 - $99	157%
Medcost Ppo City Employees	$58 - $105	165%
Medcost Ppo County Employee	$60 - $109	171%
Benefit Mgmt, Svcs-All Plans	$67 - $122	191%
Aetna	$70 - $128	200%
Medcost Benefit Svc-All Other Plans	$70 - $127	200%
Acs Consult Svc Inc-All Plans	$71 - $130	202%
Medcost Ppo Standard	$71 - $130	202%
Cigna	$72 - $131	205%

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 $67.
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 Carolina East 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.