CMS Price Transparency Data

Occupational therapy (self-care training)

Facility: University of Miami Hospital and Clinics

Billing Code: 97535 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97535
Insurance Median: $448
Cash Discount Price: $202
vs. Medicare Baseline: 13.83x Medicare

The contracted insurance negotiated median rate for a Occupational therapy (self-care training) at University of Miami Hospital and Clinics is $448. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $202. Compared to the federal Medicare reimbursement reference rate of $32.4, this hospital’s rate is 13.83x the Medicare baseline. Located in 1475 Nw 12Th Ave Suite 2175, Miami, FL.

Cash / Self-Pay

$202

Average discount available for prompt cash payment at this facility.

Insurance Median

$448

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: $202 (623%)

Insurance Median: $448 (1383%)

Cash: $202 (623% of Medicare)

Ins. Median: $448 (1383% 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 1383% of the Medicare baseline (a markup of 1283%). 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
UnitedHealthcare	$171 - $303	528%
Careplus	$187	577%
Sunshine Health	$187	577%
Molina Healthcare Of Fl	$202	623%
Amerihealth Caritas Fl	$209	645%
Oscar Health Of Fl	$209	645%
Cigna	$249 - $300	769%
Aetna	$260 - $410	802%
Avmed	$281 - $323	867%
Blue Cross Blue Shield	$373 - $884	1151%
Curative	$396	1222%
Employers Health Network	$448	1383%
Simply Healthcare	$448	1383%
First Health	$486	1500%
Health First New York Health Insurance	$486	1500%
Broward Health	$523	1614%
Beech Street	$598	1846%
Dimension Health	$598	1846%
Multiplan	$598	1846%

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 $202.
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 University of Miami Hospital and Clinics 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.