CMS Price Transparency Data

Occupational therapy (self-care training)

Facility: Penn Medicine | Good Shepherd Rehabilitation

Billing Code: 97535 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97535
Insurance Median: $40
Cash Discount Price: $150
vs. Medicare Baseline: 1.23x Medicare

The contracted insurance negotiated median rate for a Occupational therapy (self-care training) at Penn Medicine | Good Shepherd Rehabilitation is $40. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $150. Compared to the federal Medicare reimbursement reference rate of $32.4, this hospital’s rate is 1.23x the Medicare baseline. Located in 1800 Lombard St, Fifth Floor, Philadelphia, PA.

Cash / Self-Pay

$150

Average discount available for prompt cash payment at this facility.

Insurance Median

$40

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: $150 (463%)

Insurance Median: $40 (123%)

Cash: $150 (463% of Medicare)

Ins. Median: $40 (123% 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
Blue Cross Blue Shield	$28 - $47	86%
Humana	$31 - $34	96%
Choice Care	$33	102%
Cigna	$33 - $151	102%
Clover Health	$33	102%
Geisinger Commercial	$33 - $44	102%
Highmark Wholecare	$33	102%
Keystone First	$33 - $51	102%
Medicare (plans)	$33	102%
PA Health & Wellness	$33 - $35	102%
UnitedHealthcare	$49 - $190	151%
Imagine	$58	179%
Preferred Health Care	$73	225%
Aetna	$88	272%
Prime Health	$125	386%
Devon Health	$143	441%
Multiplan	$143	441%
Highmark Sepa	$206	636%

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 $150.
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 Medicine | Good Shepherd Rehabilitation 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.