CMS Price Transparency Data

Occupational therapy (self-care training)

Facility: Lewisgale Hospital Alleghany

Billing Code: 97535 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97535
Insurance Median: $33
Cash Discount Price: $381
vs. Medicare Baseline: 1.02x Medicare

The contracted insurance negotiated median rate for a Occupational therapy (self-care training) at Lewisgale Hospital Alleghany is $33. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $381. Compared to the federal Medicare reimbursement reference rate of $32.4, this hospital’s rate is 1.02x the Medicare baseline. Located in One Arh Lane - Po Box 7, Low Moor, VA.

Cash / Self-Pay

$381

Average discount available for prompt cash payment at this facility.

Insurance Median

$33

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: $381 (1176%)

Insurance Median: $33 (102%)

Cash: $381 (1176% of Medicare)

Ins. Median: $33 (102% 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
Triatlantic	$27	83%
Aetna	$28 - $206	86%
Devoted	$28 - $32	86%
Good Samaritan Hospice	$28 - $32	86%
Humana	$28 - $32	86%
Sentara Health	$28 - $32	86%
United	$28 - $171	86%
United Behavioral Health	$28 - $32	86%
United Mine Workers	$28 - $32	86%
Blue Cross Blue Shield	$29 - $33	90%
Cigna	$29 - $33	90%
Health Net	$29	90%
Virginia Premier Health	$29 - $33	90%
Align Senior Care	$30 - $34	93%
Clear Spring Health Plan	$30 - $34	93%
Lifeworks	$72	222%
Universal Healthcare Group	$84	259%
Virginia Health Network	$133 - $271	410%
Greenbrier Sporting Club	$138	426%
Greenvbrier Sporting Club	$229	707%
Corvel	$274	846%
Csx Hotels	$305	941%
Occunet Workers Comp	$305	941%
Health Payors Organization	$324	1000%
4Most	$343	1059%
Alleghany Highland Community	$343	1059%
American Postal Workers Union	$343	1059%
C&O Employees Hospital Assn	$343	1059%
Community Care Network	$343	1059%
Multiplan	$343	1059%
One Health Plan	$343	1059%

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 $381.
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 Alleghany 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.