CMS Price Transparency Data
Occupational therapy (self-care training)
Facility: Palmetto General Hospital
Billing Code: 97535 (CPT)
Factual Cost Summary (Answer Capsule)
- CPT Billing Code: 97535
- Insurance Median: $64
- Cash Discount Price: $261
- vs. Medicare Baseline: 1.98x Medicare
The contracted insurance negotiated median rate for a Occupational therapy (self-care training) at Palmetto General Hospital is $64. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $261. Compared to the federal Medicare reimbursement reference rate of $32.4, this hospital’s rate is 1.98x the Medicare baseline. Located in 2001 W 68Th St, Hialeah, FL.
Cash / Self-Pay
$261
Average discount available for prompt cash payment at this facility.
Insurance Median
$64
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: $261 (806%)
Insurance Median: $64 (198%)
Cash: $261 (806% of Medicare)
Ins. Median: $64 (198% 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
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Commercial Insurance Negotiated Rates
Negotiated contract ranges established by major commercial carriers at this facility.
| Carrier / Plan Group | Contract Rate Range | vs. Medicare Reference |
|---|---|---|
| Aetna | $5 - $262 | 15% |
| Bc/Bs Myblue Hmo Hix | $23 - $56 | 71% |
| Bc/Bs Of Fl Health Options Hmo | $23 - $56 | 71% |
| Bc/Bs Of Fl Network Blue | $23 - $56 | 71% |
| Bc/Bs Of Fl Simplyblue | $23 - $56 | 71% |
| Veterans Administration Mill Bill | $23 | 71% |
| Bc/Bs Of Fl Blue Select Exchange Non Par | $25 - $60 | 77% |
| Bc/Bs Of Fl Ppo | $26 - $63 | 80% |
| Cigna | $26 - $185 | 80% |
| Medicare (plans) | $29 - $370 | 90% |
| Bc/Bs Of Fl Miami Dade Blue Select | $31 - $74 | 96% |
| Humana | $31 - $75 | 96% |
| Devoted Health | $32 | 99% |
| Leon Health Inc | $32 | 99% |
| UnitedHealthcare | $32 - $362 | 99% |
| Bristol Hospice- Miami Dade Llc | $33 | 102% |
| Catholic Hospice | $33 | 102% |
| Compassionate Care Hospice Of Miami Dade And The Fl Keys Inc | $33 | 102% |
| Employer Direct Healthcare | $33 - $41 | 102% |
| Hospice Other | $33 | 102% |
| Ima Evalutations Inc | $33 | 102% |
| Odyssey Healthcare Of Marion County Dba Kindred Hospice | $33 | 102% |
| Opuscare Of South Fl | $33 | 102% |
| Seasons Hospice And Pallative Care Of Southern Florida Inc | $33 | 102% |
| Select Specialty Hospital | $33 | 102% |
| Tricare | $33 | 102% |
| Veterans Administration Vaccn | $33 | 102% |
| Vitas Healthcare Hospice | $33 | 102% |
| Westchester General Hospital | $33 | 102% |
| Healthsun Health Plans | $34 | 105% |
| Longevity Health Plan | $35 | 108% |
| Medicaid / KanCare | $38 - $370 | 117% |
| Florida Pace Centers | $39 | 120% |
| Bright Health Management Commercial | $40 | 123% |
| Dimension Health Wc | $40 | 123% |
| Workers Compensation | $40 | 123% |
| Self Pay/Uninsured | $41 | 127% |
| Naphcare Inc | $45 | 139% |
| Avmed Exchange | $58 | 179% |
| Ambetter / Centene | $61 | 188% |
| Molina Marketplace Program Exchange | $63 | 194% |
| Auto Insurance | $66 | 204% |
| Avmed Select Network | $67 | 207% |
| Amerihealth Caritas Next Exchange | $71 | 219% |
| Bc/Bs Of Fl Phs | $76 - $185 | 235% |
| Liga Contra El Cancer | $76 - $185 | 235% |
| Magellan Behavioral Health | $91 - $222 | 281% |
| Dimensions International | $98 - $240 | 302% |
| First Health | $102 - $248 | 315% |
| Dimension Health Ppo | $114 - $277 | 352% |
| Oscar Health Plan Hix | $114 | 352% |
| Beacon Health Strategies Commercial | $152 - $370 | 469% |
| Commercial Non-Contracted | $152 - $370 | 469% |
| Self Pay - Mcd Pending 100 Percent | $152 - $370 | 469% |
| Single Case Agreement | $152 - $370 | 469% |
| United Behavioral Health Psych | $152 - $370 | 469% |
| Imagine Health | $161 | 497% |
| Avmed Broad Network | $174 | 537% |