CMS Price Transparency Data

Occupational therapy (self-care training)

Facility: Penn State Health Lancaster Medical Center

Billing Code: 97535 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97535
Insurance Median: $32
Cash Discount Price: $58
vs. Medicare Baseline: 0.99x Medicare

The contracted insurance negotiated median rate for a Occupational therapy (self-care training) at Penn State Health Lancaster Medical Center is $32. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $58. Compared to the federal Medicare reimbursement reference rate of $32.4, this hospital’s rate is 0.99x the Medicare baseline. Located in 2160 State Road, Lancaster, PA.

Cash / Self-Pay

$58

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: $58 (179%)

Insurance Median: $32 (99%)

Cash: $58 (179% 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
[Amerihealth Caritas]	$26 - $31	80%
[Highmark Wholecare]	$26 - $31	80%
[Geisinger]	$28 - $133	86%
[Health Partners Plans]	$29 - $32	90%
[Pa Health & Wellness]	$29 - $32	90%
Aetna	$31 - $156	96%
Humana	$31	96%
UnitedHealthcare	$31 - $125	96%
[Cbc]	$31 - $100	96%
[Healthspring]	$31	96%
[Highmark]	$31 - $95	96%
[Upmc]	$32 - $147	99%
[Point Comfort Underwriters]	$39	120%
[Highmark Choice Blue]	$76	235%
[Highmark Aca]	$79	244%
Cigna	$122	377%
[First Health]	$159	491%
[Multiplan]	$159	491%

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 $58.
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 Penn State Health Lancaster 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.