CMS Price Transparency Data

Occupational therapy (therapeutic activities)

Facility: PAM Specialty Hospital of Rocky Mount LLC

Billing Code: 97530 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97530
Insurance Median: $290
Cash Discount Price: $364
vs. Medicare Baseline: 8.27x Medicare

The contracted insurance negotiated median rate for a Occupational therapy (therapeutic activities) at PAM Specialty Hospital of Rocky Mount LLC is $290. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $364. Compared to the federal Medicare reimbursement reference rate of $35.07, this hospital’s rate is 8.27x the Medicare baseline. Located in 1051 Noell Ln, Rocky Mount, NC.

Cash / Self-Pay

$364

Average discount available for prompt cash payment at this facility.

Insurance Median

$290

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: $364 (1038%)

Insurance Median: $290 (827%)

Cash: $364 (1038% of Medicare)

Ins. Median: $290 (827% 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 827% of the Medicare baseline (a markup of 727%). 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
America'S Choice	$235 - $275	670%
Provider Network Of America	$252 - $294	719%
Quik Trip	$252 - $294	719%
Usa Managed Care Organization	$252 - $294	719%
Velocity Provider Ppo Network	$252 - $294	719%
Healthsmart	$262 - $306	747%
Evolutions Healthcare System	$269 - $314	767%
Multiplan/Phcs	$269 - $314	767%
Fortified Provider Network	$286 - $334	816%
Prime Health Services	$286 - $334	816%
Integrated Health Plan	$319 - $373	910%

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 $364.
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 PAM Specialty Hospital of Rocky Mount LLC 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.