CMS Price Transparency Data

Occupational therapy (self-care training)

Facility: Pender Memorial Hospital

Billing Code: 97535 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97535
Insurance Median: $74
Cash Discount Price: $54
vs. Medicare Baseline: 2.28x Medicare

The contracted insurance negotiated median rate for a Occupational therapy (self-care training) at Pender Memorial Hospital is $74. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $54. Compared to the federal Medicare reimbursement reference rate of $32.4, this hospital’s rate is 2.28x the Medicare baseline. Located in 507 E Fremont St, Burgaw, NC.

Cash / Self-Pay

$54

Average discount available for prompt cash payment at this facility.

Insurance Median

$74

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: $54 (167%)

Insurance Median: $74 (228%)

Cash: $54 (167% of Medicare)

Ins. Median: $74 (228% 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 228% of the Medicare baseline (a markup of 128%). 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
Humana	$31 - $102	96%
Blue Cross Blue Shield	$32 - $86	99%
Pace Of The Southern Piedmont	$32	99%
Aetna	$33 - $101	102%
Carolina Complete	$33	102%
Cigna	$33 - $52	102%
Nc Department Of Public Safety	$33 - $64	102%
New Hanover Health	$33	102%
Amerihealth	$34	105%
Wellcare	$34	105%
Ambetter / Centene	$45	139%
Liberty Health	$46	142%
Caresource North Carolina	$48	148%
Plotkin Health	$71	219%
UnitedHealthcare	$87	269%
Medcost	$90 - $100	278%
Employers Choice Network	$115	355%
Three Rivers Provider Network	$115	355%

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 $54.
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 Pender Memorial Hospital 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.