CMS Price Transparency Data

Occupational therapy (self-care training)

Facility: Villages Regional Hospital, The

Billing Code: 97535 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97535
Insurance Median: $44
Cash Discount Price: $118
vs. Medicare Baseline: 1.36x Medicare

The contracted insurance negotiated median rate for a Occupational therapy (self-care training) at Villages Regional Hospital, The is $44. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $118. Compared to the federal Medicare reimbursement reference rate of $32.4, this hospital’s rate is 1.36x the Medicare baseline. Located in 1451 El Camino Real, The Villages, FL.

Cash / Self-Pay

$118

Average discount available for prompt cash payment at this facility.

Insurance Median

$44

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: $118 (364%)

Insurance Median: $44 (136%)

Cash: $118 (364% of Medicare)

Ins. Median: $44 (136% 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
Humana	$19 - $97	59%
Simply Healthcare	$19	59%
Sunshine State	$23	71%
Careplus	$42 - $43	130%
UnitedHealthcare	$42	130%
Wellcare	$43	133%
Aetna	$44 - $144	136%
Freedom Health	$44	136%
Ultimate Health	$45	139%
Blue Cross Blue Shield	$120 - $129	370%
Cigna	$149	460%
Mulitplan	$178	549%

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 $118.
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 Villages Regional Hospital, The 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.