CMS Price Transparency Data

Occupational therapy (self-care training)

Facility: Lewisgale Hospital Pulaski

Billing Code: 97535 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97535
Insurance Median: $167
Cash Discount Price: $280
vs. Medicare Baseline: 5.15x Medicare

The contracted insurance negotiated median rate for a Occupational therapy (self-care training) at Lewisgale Hospital Pulaski is $167. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $280. Compared to the federal Medicare reimbursement reference rate of $32.4, this hospital’s rate is 5.15x the Medicare baseline. Located in 2400 Lee Highway, Pulaski, VA.

Cash / Self-Pay

$280

Average discount available for prompt cash payment at this facility.

Insurance Median

$167

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: $280 (864%)

Insurance Median: $167 (515%)

Cash: $280 (864% of Medicare)

Ins. Median: $167 (515% 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 515% of the Medicare baseline (a markup of 415%). 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
Humana	$24 - $33	74%
Triatlantic	$27	83%
Aetna	$29 - $134	90%
Devoted	$29 - $33	90%
Good Samaritan Hospice	$29 - $33	90%
Health Net	$29	90%
Magellan	$29 - $33	90%
Sentara Health	$29 - $33	90%
United	$29 - $134	90%
United Mine Workers	$29 - $33	90%
Blue Cross Blue Shield	$30 - $34	93%
Cigna	$30 - $34	93%
Clear Spring Health Plan	$30 - $35	93%
Evernorth Behavioral Health	$30 - $34	93%
Virginia Premier Health	$30 - $34	93%
Align Senior Care	$31 - $35	96%
Pyramid Life	$31 - $35	96%
Lifeworks	$44 - $57	136%
Universal Healthcare Group	$50 - $66	154%
Virginia Health Network	$80 - $212	247%
Greenvbrier Sporting Club	$137 - $179	423%
Corvel	$165 - $215	509%
Richfield Nursing Center	$172 - $224	531%
Richfield Retirement Community	$172 - $224	531%
Multiplan	$176 - $229	543%
Community Care Network	$183 - $238	565%
Graham-White Manufacturing	$183 - $238	565%
Occunet Workers Comp	$183 - $238	565%
One Health Plan	$183 - $238	565%
Patients Choice	$202 - $262	623%
4Most	$206 - $268	636%
American Postal Workers Union	$206 - $268	636%
Phcs	$206 - $268	636%
Star Transportation	$206 - $268	636%

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 $280.
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 Lewisgale Hospital Pulaski 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.