CMS Price Transparency Data

Occupational therapy (self-care training)

Facility: HCA Florida Twin Cities Hospital

Billing Code: 97535 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97535
Insurance Median: $34
Cash Discount Price: $271
vs. Medicare Baseline: 1.05x Medicare

The contracted insurance negotiated median rate for a Occupational therapy (self-care training) at HCA Florida Twin Cities Hospital is $34. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $271. Compared to the federal Medicare reimbursement reference rate of $32.4, this hospital’s rate is 1.05x the Medicare baseline. Located in 2190 Hwy 85 N, Niceville, FL.

Cash / Self-Pay

$271

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: $271 (836%)

Insurance Median: $34 (105%)

Cash: $271 (836% 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
Humana	$28 - $103	86%
Ndms Definitive Care	$28 - $32	86%
Regency Hospice	$28 - $32	86%
United	$28 - $122	86%
Wellmed	$28 - $32	86%
Aetna	$29 - $81	90%
Blue Cross Blue Shield	$29 - $32	90%
Sunshine State	$29 - $33	90%
Wellcare	$29 - $33	90%
American Health Plan	$30 - $34	93%
Florida Complete Care	$30 - $34	93%
Healthspring Of Florida	$30 - $34	93%
Centurion	$31 - $35	96%
Clear Spring Health	$31 - $35	96%
Gold Kidney Of Florida	$31 - $35	96%
Ultimate Health Plan	$32 - $37	99%
Longevity Health Plan	$34 - $38	105%
Oscar	$35	108%
Corvel Corporation	$36	111%
Prime Health	$37	114%
Careworks (Rockport Community)	$38	117%
Simply Healthcare	$45	139%
Cigna	$47 - $112	145%
Molina Healthcare	$51 - $87	157%
Avmed	$65 - $136	201%
Sunshine State Health Plan	$69	213%
Plotkin Health	$136	420%
Prime Health Sheriff	$136	420%
Evolutions Healthcare	$176 - $230	543%
Multiplan	$211 - $230	651%
Ppo Next	$230	710%
Novanet	$244	753%

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 $271.
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 HCA Florida Twin Cities 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.