CMS Price Transparency Data

Occupational therapy (self-care training)

Facility: Sarasota Memorial Hospital

Billing Code: 97535 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97535
Insurance Median: $50
Cash Discount Price: $74
vs. Medicare Baseline: 1.54x Medicare

The contracted insurance negotiated median rate for a Occupational therapy (self-care training) at Sarasota Memorial Hospital is $50. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $74. Compared to the federal Medicare reimbursement reference rate of $32.4, this hospital’s rate is 1.54x the Medicare baseline. Located in 1700 S Tamiami Trl, Sarasota, FL.

Cash / Self-Pay

$74

Average discount available for prompt cash payment at this facility.

Insurance Median

$50

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: $74 (228%)

Insurance Median: $50 (154%)

Cash: $74 (228% of Medicare)

Ins. Median: $50 (154% 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
Simply Healthcare	$19 - $20	59%
Molina	$20	62%
Sunshine State	$20	62%
Amerihealth Caritas	$21	65%
Community Care Plan	$21	65%
Florida Community Care	$21 - $34	65%
UnitedHealthcare	$30 - $168	93%
Blue Cross Blue Shield	$31 - $53	96%
Aetna	$32 - $179	99%
Simply Freedom Optimum	$33	102%
Wellcare	$33	102%
Simply Freedom Optimum Oncology	$34	105%
Wellcare Oncology	$34	105%
Florida Community Care Oncology	$39	120%
Oscar Oncology	$54	167%
Ambetter / Centene	$84	259%
Avmed	$108 - $164	333%
Usa Managed Care	$118 - $179	364%
First Health	$123 - $186	380%

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 $74.
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 Sarasota Memorial 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.