CMS Price Transparency Data

Occupational therapy (self-care training)

Facility: Lonesome Pine Hospital

Billing Code: 97535 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97535
Insurance Median: $34
Cash Discount Price: $34
vs. Medicare Baseline: 1.05x Medicare

The contracted insurance negotiated median rate for a Occupational therapy (self-care training) at Lonesome Pine Hospital is $34. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $34. Compared to the federal Medicare reimbursement reference rate of $32.4, this hospital’s rate is 1.05x the Medicare baseline. Located in 1990 Holton Avenue East, Big Stone Gap, VA.

Cash / Self-Pay

$34

Average discount available for prompt cash payment at this facility.

Insurance Median

$34

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: $34 (105%)

Insurance Median: $34 (105%)

Cash: $34 (105% of Medicare)

Ins. Median: $34 (105% 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
Amerigroup	$30 - $32	93%
Aetna	$32 - $96	99%
Blue Cross Blue Shield	$32 - $224	99%
Humana	$32	99%
Managed Medicaire	$32	99%
Medicare (plans)	$32	99%
Sentara Health	$32 - $57	99%
United Mine Workers Of America	$32	99%
UnitedHealthcare	$32 - $224	99%
Cigna	$34 - $104	105%
Devoted Health Plan	$34	105%
Molina Healthcare	$34 - $37	105%
Mountain Empire Pace	$34	105%
Nhc Advantage	$34	105%
Wellcare	$34	105%
Optima Health	$37	114%
Ambetter / Centene	$70	216%
Seven Corners, Inc.	$77	238%
Medcost	$107	330%
First Health Coventry	$202	623%

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 $34.
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 Lonesome Pine 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.