CMS Price Transparency Data

Occupational therapy (self-care training)

Facility: Jersey Shore University Medical Center

Billing Code: 97535 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97535
Insurance Median: $219
Cash Discount Price: $41
vs. Medicare Baseline: 6.76x Medicare

The contracted insurance negotiated median rate for a Occupational therapy (self-care training) at Jersey Shore University Medical Center is $219. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $41. Compared to the federal Medicare reimbursement reference rate of $32.4, this hospital’s rate is 6.76x the Medicare baseline. Located in 1945 Rte 33, Neptune, NJ.

Cash / Self-Pay

$41

Average discount available for prompt cash payment at this facility.

Insurance Median

$219

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: $41 (127%)

Insurance Median: $219 (676%)

Cash: $41 (127% of Medicare)

Ins. Median: $219 (676% 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 676% of the Medicare baseline (a markup of 576%). 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
UnitedHealthcare	$33 - $367	102%
Amerigroup	$41	127%
Vaccn	$41	127%
United Community/Americhoice	$43	133%
Aetna	$44 - $215	136%
Clover	$50	154%
Karna	$54	167%
Horizon	$60 - $275	185%
Blue Cross Blue Shield	$64	198%
Seoul Medical Group	$64	198%
Qualcare	$214 - $306	660%
Cigna	$220 - $263	679%
Wellcare	$224	691%
Activecare First McO	$234	722%
Multiplan - PHCS	$234	722%
Amerihealth	$240 - $272	741%
Brighton Health Plan	$248	765%
Beacon	$262	809%
Bergen Risk	$291	898%
Oxford	$561	1731%

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 $41.
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 Jersey Shore University 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.