CMS Price Transparency Data

Occupational therapy (self-care training)

Facility: Forbes Hospital

Billing Code: 97535 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97535
Insurance Median: $32
Cash Discount Price: $123
vs. Medicare Baseline: 0.99x Medicare

The contracted insurance negotiated median rate for a Occupational therapy (self-care training) at Forbes Hospital is $32. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $123. Compared to the federal Medicare reimbursement reference rate of $32.4, this hospital’s rate is 0.99x the Medicare baseline. Located in 2570 Haymaker Road, Monroeville, PA.

Cash / Self-Pay

$123

Average discount available for prompt cash payment at this facility.

Insurance Median

$32

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: $123 (380%)

Insurance Median: $32 (99%)

Cash: $123 (380% of Medicare)

Ins. Median: $32 (99% 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.

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
Highmark	$15 - $51	46%
Univera	$27 - $36	83%
American Health Plans	$31	96%
Life Pittsburgh	$31	96%
Martin'S Point	$31	96%
Aetna	$32 - $88	99%
Amerihealth	$32	99%
Medicare (plans)	$32	99%
UnitedHealthcare	$32 - $52	99%
Cigna	$33 - $52	102%
Highmark Wholecare	$33	102%
Humana	$33	102%
Molina	$34	105%

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 $123.
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 Forbes 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.