CMS Price Transparency Data

Occupational therapy (self-care training)

Facility: HCA Florida Highlands Hospital

Billing Code: 97535 (CPT)

Factual Cost Summary (Answer Capsule)
  • CPT Billing Code: 97535
  • Insurance Median: $34
  • Cash Discount Price: $322
  • vs. Medicare Baseline: 1.05x Medicare
The contracted insurance negotiated median rate for a Occupational therapy (self-care training) at HCA Florida Highlands Hospital is $34. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $322. Compared to the federal Medicare reimbursement reference rate of $32.4, this hospital’s rate is 1.05x the Medicare baseline. Located in 3600 S Highlands Ave, Sebring, FL.
Cash / Self-Pay
$322

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: $322 (994%)
Insurance Median: $34 (105%)
Cash: $322 (994% 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.

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
Devoted Health $28 - $32 86%
Freedom Health $28 86%
Humana $28 - $129 86%
Ndms Definitive Care $28 - $32 86%
United $28 - $145 86%
Wellmed $28 - $32 86%
Aetna $29 - $97 90%
Blue Cross Blue Shield $29 - $32 90%
Prominence Healthfirst $29 - $33 90%
Sunshine State $29 - $35 90%
American Health Plan $30 - $34 93%
Cigna $30 - $113 93%
Florida Complete Care $30 - $34 93%
Centurion $31 - $35 96%
Amerihealth Caritas $34 - $38 105%
Longevity Health Plan $34 - $38 105%
Prime Health $37 114%
Avmed $42 - $161 130%
Molina $61 188%
Oscar $61 188%
Simply Healthcare $76 235%
Office Of Sheiff Highland Co $113 349%
United Ppo $142 438%

Self-Pay Upfront Cash Action Plan

Insurance In-Network Protection Plan

Facility Profile & Credentials

  • Address: 3600 S Highlands Ave, Sebring, FL 33870
  • CMS Rating: ★★★☆☆
  • Ownership Type: Proprietary
  • Hospital Type: Acute Care Hospitals