CMS Price Transparency Data

Occupational therapy (therapeutic activities)

Facility: Winter Haven Hospital

Billing Code: 97530 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97530
Insurance Median: $71
Cash Discount Price: $92
vs. Medicare Baseline: 2.02x Medicare

The contracted insurance negotiated median rate for a Occupational therapy (therapeutic activities) at Winter Haven Hospital is $71. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $92. Compared to the federal Medicare reimbursement reference rate of $35.07, this hospital’s rate is 2.02x the Medicare baseline. Located in 200 Ave F Ne, Winter Haven, FL.

Cash / Self-Pay

$92

Average discount available for prompt cash payment at this facility.

Insurance Median

$71

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$35.07

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $35.07 (100%)

Cash / Self-Pay: $92 (262%)

Insurance Median: $71 (202%)

Cash: $92 (262% of Medicare)

Ins. Median: $71 (202% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $35.07 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 202% of the Medicare baseline (a markup of 102%). 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
Clear Health Alliance	$22	63%
Freedom Health	$23	66%
Humana	$23 - $33	66%
Molina Healthcare	$23	66%
Simply Healthcare	$23 - $28	66%
Sunshine Health	$23	66%
UnitedHealthcare	$23 - $139	66%
Aetna	$24 - $126	68%
Baycareplus	$24	68%
Blue Cross Blue Shield	$24 - $89	68%
Florida Community Care	$24	68%
Solis Health	$27	77%
Cigna	$28 - $134	80%
Health First	$28	80%
Molina	$28 - $91	80%
Wellcare	$34	97%
Careplus	$40	114%
Freedom	$43	123%
Optimum	$43	123%
Ultimate Health Plan	$46	131%
Avmed	$48 - $75	137%
Ambetter / Centene	$54 - $154	154%
Florida Hospital	$71	202%
Evolutions	$77 - $143	220%
Multiplan	$123	351%
First Health	$131	374%
United Behavioral Health	$154	439%

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 $92.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 97530.

Insurance In-Network Protection Plan

Contact your insurance company to confirm Winter Haven Hospital is fully in-network.
Ask your insurer if "Prior Authorization" is required for CPT code 97530.
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.