CMS Price Transparency Data

Occupational therapy (therapeutic activities)

Facility: University of Miami Hospital and Clinics

Billing Code: 97530 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97530
Insurance Median: $225
Cash Discount Price: $92
vs. Medicare Baseline: 6.42x Medicare

The contracted insurance negotiated median rate for a Occupational therapy (therapeutic activities) at University of Miami Hospital and Clinics is $225. 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 6.42x the Medicare baseline. Located in 1475 Nw 12Th Ave Suite 2175, Miami, FL.

Cash / Self-Pay

$92

Average discount available for prompt cash payment at this facility.

Insurance Median

$225

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: $225 (642%)

Cash: $92 (262% of Medicare)

Ins. Median: $225 (642% 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 642% of the Medicare baseline (a markup of 542%). 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
Careplus	$80 - $90	228%
Sunshine Health	$80 - $90	228%
Molina Healthcare Of Fl	$87 - $97	248%
Amerihealth Caritas Fl	$90 - $101	257%
Oscar Health Of Fl	$90 - $101	257%
Aetna	$112 - $197	319%
Curative	$170 - $190	485%
UnitedHealthcare	$171 - $303	488%
Employers Health Network	$193 - $215	550%
Simply Healthcare	$193 - $215	550%
First Health	$209 - $233	596%
Health First New York Health Insurance	$209 - $233	596%
Broward Health	$225 - $251	642%
Cigna	$249 - $300	710%
Beech Street	$257 - $287	733%
Dimension Health	$257 - $287	733%
Multiplan	$257 - $287	733%
Avmed	$281 - $323	801%
Blue Cross Blue Shield	$373 - $884	1064%

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 University of Miami Hospital and Clinics 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.