CMS Price Transparency Data
Occupational therapy (therapeutic activities)
Facility: Palmetto General Hospital
Billing Code: 97530 (CPT)
Factual Cost Summary (Answer Capsule)
- CPT Billing Code: 97530
- Insurance Median: $69
- Cash Discount Price: $654
- vs. Medicare Baseline: 1.97x Medicare
The contracted insurance negotiated median rate for a Occupational therapy (therapeutic activities) at Palmetto General Hospital is $69. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $654. Compared to the federal Medicare reimbursement reference rate of $35.07, this hospital’s rate is 1.97x the Medicare baseline. Located in 2001 W 68Th St, Hialeah, FL.
Cash / Self-Pay
$654
Average discount available for prompt cash payment at this facility.
Insurance Median
$69
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: $654 (1865%)
Insurance Median: $69 (197%)
Cash: $654 (1865% of Medicare)
Ins. Median: $69 (197% 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.
Out-of-Pocket Cost Estimator
Estimate whether it is more economical to use your insurance or pay the upfront self-pay cash 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 |
|---|---|---|
| Aetna | $20 - $464 | 57% |
| Veterans Administration Mill Bill | $25 | 71% |
| Medicare (plans) | $32 - $654 | 91% |
| Humana | $34 - $75 | 97% |
| Devoted Health | $35 | 100% |
| Leon Health Inc | $35 | 100% |
| UnitedHealthcare | $35 - $362 | 100% |
| Bristol Hospice- Miami Dade Llc | $36 | 103% |
| Catholic Hospice | $36 | 103% |
| Compassionate Care Hospice Of Miami Dade And The Fl Keys Inc | $36 | 103% |
| Employer Direct Healthcare | $36 - $45 | 103% |
| Hospice Other | $36 | 103% |
| Ima Evalutations Inc | $36 | 103% |
| Odyssey Healthcare Of Marion County Dba Kindred Hospice | $36 | 103% |
| Opuscare Of South Fl | $36 | 103% |
| Seasons Hospice And Pallative Care Of Southern Florida Inc | $36 | 103% |
| Select Specialty Hospital | $36 | 103% |
| Veterans Administration Vaccn | $36 | 103% |
| Vitas Healthcare Hospice | $36 | 103% |
| Westchester General Hospital | $36 | 103% |
| Cigna | $37 - $327 | 106% |
| Healthsun Health Plans | $37 | 106% |
| Longevity Health Plan | $37 | 106% |
| Tricare | $37 | 106% |
| Dimension Health Wc | $40 | 114% |
| Workers Compensation | $40 | 114% |
| Florida Pace Centers | $42 | 120% |
| Bright Health Management Commercial | $43 | 123% |
| Self Pay/Uninsured | $44 | 125% |
| Naphcare Inc | $49 | 140% |
| Avmed Exchange | $62 | 177% |
| Ambetter / Centene | $66 | 188% |
| Molina Marketplace Program Exchange | $68 | 194% |
| Auto Insurance | $71 | 202% |
| Avmed Select Network | $73 | 208% |
| Amerihealth Caritas Next Exchange | $77 | 220% |
| Bc/Bs Myblue Hmo Hix | $100 | 285% |
| Bc/Bs Of Fl Health Options Hmo | $100 | 285% |
| Bc/Bs Of Fl Network Blue | $100 | 285% |
| Bc/Bs Of Fl Simplyblue | $100 | 285% |
| Bc/Bs Of Fl Blue Select Exchange Non Par | $106 | 302% |
| Bc/Bs Of Fl Ppo | $112 | 319% |
| Oscar Health Plan Hix | $114 | 325% |
| Bc/Bs Of Fl Miami Dade Blue Select | $132 | 376% |
| Imagine Health | $161 | 459% |
| Medicaid / KanCare | $164 - $654 | 468% |
| Avmed Broad Network | $174 | 496% |
| Liga Contra El Cancer | $327 | 932% |
| Bc/Bs Of Fl Phs | $328 | 935% |
| Magellan Behavioral Health | $392 | 1118% |
| Dimensions International | $425 | 1212% |
| First Health | $438 | 1249% |
| Dimension Health Ppo | $490 | 1397% |
| Beacon Health Strategies Commercial | $654 | 1865% |
| Commercial Non-Contracted | $654 | 1865% |
| Self Pay - Mcd Pending 100 Percent | $654 | 1865% |
| Single Case Agreement | $654 | 1865% |
| United Behavioral Health Psych | $654 | 1865% |