Occupational therapy (self-care training)
Facility: Lewisgale Hospital Montgomery
Billing Code: 97535 (CPT)
- CPT Billing Code: 97535
- Insurance Median: $71
- Cash Discount Price: $195
- vs. Medicare Baseline: 2.19x Medicare
Average discount available for prompt cash payment at this facility.
Median negotiated contract rate across all mapped commercial carriers.
Standard federal government reimbursement rate for this code.
Visual Cost Comparison vs. 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 219% of the Medicare baseline (a markup of 119%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.
Out-of-Pocket Cost Estimator
Estimate whether it is more economical to use your insurance or pay the upfront self-pay cash rate.
Commercial Insurance Negotiated Rates
Negotiated contract ranges established by major commercial carriers at this facility.
| Carrier / Plan Group | Contract Rate Range | vs. Medicare Reference |
|---|---|---|
| Triatlantic | $27 | 83% |
| Aetna | $29 - $33 | 90% |
| Devoted | $29 - $33 | 90% |
| Good Samaritan Hospice | $29 - $33 | 90% |
| Health Net | $29 | 90% |
| Humana | $29 - $33 | 90% |
| Sentara Health | $29 - $33 | 90% |
| United | $29 - $91 | 90% |
| United Mine Workers | $29 - $33 | 90% |
| Blue Cross Blue Shield | $30 - $34 | 93% |
| Cigna | $30 - $35 | 93% |
| Clear Spring Health Plan | $30 - $35 | 93% |
| Virginia Premier Health | $30 - $34 | 93% |
| Align Senior Care | $31 - $35 | 96% |
| Pyramid Life | $31 - $35 | 96% |
| Lifeworks | $36 - $38 | 111% |
| Universal Healthcare Group | $41 - $44 | 127% |
| Virginia Health Network | $65 - $143 | 201% |
| Greenvbrier Sporting Club | $112 - $121 | 346% |
| Corvel | $135 - $145 | 417% |
| Richfield Nursing Center | $140 - $152 | 432% |
| Richfield Retirement Community | $140 - $152 | 432% |
| Multiplan | $144 - $156 | 444% |
| Community Care Network | $150 - $162 | 463% |
| Graham-White Manufacturing | $150 - $162 | 463% |
| Occunet Workers Comp | $150 - $162 | 463% |
| One Health Plan | $150 - $162 | 463% |
| Phcs | $159 - $172 | 491% |
| Patients Choice | $165 - $178 | 509% |
| 4Most | $168 - $182 | 519% |
| American Postal Workers Union | $168 - $182 | 519% |
| Star Transportation | $168 - $182 | 519% |