CMS Price Transparency Data

Occupational therapy (self-care training)

Facility: Good Shepherd Rehabilitation Hospital

Billing Code: 97535 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97535
Insurance Median: $40
Cash Discount Price: $33
vs. Medicare Baseline: 1.23x Medicare

The contracted insurance negotiated median rate for a Occupational therapy (self-care training) at Good Shepherd Rehabilitation Hospital is $40. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $33. Compared to the federal Medicare reimbursement reference rate of $32.4, this hospital’s rate is 1.23x the Medicare baseline. Located in 3200 Center Valley Parkway, Center Valley, PA.

Cash / Self-Pay

$33

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: $33 (102%)

Insurance Median: $40 (123%)

Cash: $33 (102% 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
Lehigh Valley Health Network	$18	56%
Multiplan	$21	65%
Prime Health	$21	65%
Devon Health	$28	86%
Geisinger	$29 - $44	90%
Blue Cross Blue Shield	$29 - $115	90%
Humana	$29 - $31	90%
Medicare (plans)	$31	96%
UPMC	$31 - $49	96%
Everyday Life	$31	96%
Cigna	$31 - $148	96%
PA Health and Wellness	$31 - $36	96%
Keystone First	$31 - $44	96%
Amerihealth Caritas PA	$31 - $44	96%
Clover Health	$31	96%
Choice Care	$31	96%
Highmark Wholecare	$31 - $49	96%
Aetna	$51 - $144	157%
Highmark	$60	185%
UnitedHealthcare	$79	244%
Amerihealth	$115	355%

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 $33.
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 Good Shepherd Rehabilitation 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.