CMS Price Transparency Data

Occupational therapy (self-care training)

Facility: HCA Florida Lehigh Hospital

Billing Code: 97535 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97535
Insurance Median: $41
Cash Discount Price: $554
vs. Medicare Baseline: 1.27x Medicare

The contracted insurance negotiated median rate for a Occupational therapy (self-care training) at HCA Florida Lehigh Hospital is $41. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $554. Compared to the federal Medicare reimbursement reference rate of $32.4, this hospital’s rate is 1.27x the Medicare baseline. Located in 1500 Lee Blvd, Lehigh Acres, FL.

Cash / Self-Pay

$554

Average discount available for prompt cash payment at this facility.

Insurance Median

$41

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: $554 (1710%)

Insurance Median: $41 (127%)

Cash: $554 (1710% of Medicare)

Ins. Median: $41 (127% 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
Freedom Health Care	$16 - $43	49%
Optimum Healthcare	$16 - $43	49%
Simply Healthcare	$26 - $85	80%
Aetna	$28 - $166	86%
United	$28 - $91	86%
Wellmed	$28 - $32	86%
Blue Cross Blue Shield	$29 - $32	90%
Humana	$29 - $35	90%
Oscar	$30 - $83	93%
Wellcare	$30 - $34	93%
Caresource	$31	96%
Longevity Health Plan	$34 - $38	105%
Cigna	$35 - $96	108%
Evolutions Healthcare Systems	$47 - $510	145%
Sunshine State Health Plan	$52 - $141	160%
Plotkin Health	$101 - $277	312%

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 $554.
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 Lehigh 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.