CMS Price Transparency Data

Occupational therapy (self-care training)

Facility: Uva Health Culpeper Medical Center

Billing Code: 97535 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97535
Insurance Median: $72
Cash Discount Price: $84
vs. Medicare Baseline: 2.22x Medicare

The contracted insurance negotiated median rate for a Occupational therapy (self-care training) at Uva Health Culpeper Medical Center is $72. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $84. Compared to the federal Medicare reimbursement reference rate of $32.4, this hospital’s rate is 2.22x the Medicare baseline. Located in 501 Sunset Lane, Culpeper, VA.

Cash / Self-Pay

$84

Average discount available for prompt cash payment at this facility.

Insurance Median

$72

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: $84 (259%)

Insurance Median: $72 (222%)

Cash: $84 (259% of Medicare)

Ins. Median: $72 (222% 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.

Elevated Commercial Rate Alert (Value-Gap)

The negotiated rate at this facility is 222% of the Medicare baseline (a markup of 122%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.

Consult Patient Advocate

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 Ridge Pace [10510]	$29	90%
Medicaid / KanCare	$29	90%
Veterans [99909]	$30	93%
Aetna	$32 - $161	99%
Blue Cross Blue Shield	$32 - $33	99%
Cigna	$32 - $360	99%
HMO Part B [10099]	$32	99%
Humana	$32 - $33	99%
Medicare (plans)	$32	99%
UnitedHealthcare	$32 - $282	99%
VA Ccn [99926]	$32	99%
VA Ccn [99927]	$32	99%
Veterans Administration [99910]	$32	99%
Champva [50002]	$33	102%
Tricare	$33	102%
Carefirst [30007]	$59 - $63	182%
Sentara [40021]	$71 - $103	219%
Sentara Behavioral Health [40052]	$72 - $103	222%
Beacon Health Options [40012]	$84	259%
Commercial Contracted Hb Only [40056]	$89	275%
Commercial Generic [40000]	$89 - $118	275%
Geha [40009]	$98 - $228	302%
Commercial Contracted Tpa [40055]	$101 - $118	312%
Multiplan Generic [40035]	$101 - $144	312%
Vhn Generic [40040]	$101 - $144	312%
Umwa [40037]	$118	364%
Kaiser Permenente [40014]	$120	370%
Healthsmart [40013]	$127	392%
First Health Generic [40033]	$139	429%
Gateway Health Alliance [40034]	$144	444%
Onenet Workers Comp Generic [60010]	$148	457%

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 $84.
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 Uva Health Culpeper 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.