CMS Price Transparency Data

Occupational therapy (self-care training)

Facility: Gulf Breeze Hospital

Billing Code: 97535 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97535
Insurance Median: $50
Cash Discount Price: $25
vs. Medicare Baseline: 1.54x Medicare

The contracted insurance negotiated median rate for a Occupational therapy (self-care training) at Gulf Breeze Hospital is $50. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $25. Compared to the federal Medicare reimbursement reference rate of $32.4, this hospital’s rate is 1.54x the Medicare baseline. Located in 1110 Gulf Breeze Pkwy, Gulf Breeze, FL.

Cash / Self-Pay

$25

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: $25 (77%)

Insurance Median: $50 (154%)

Cash: $25 (77% 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
Aetna	$18 - $151	56%
Cha Health Plan	$18	56%
UnitedHealthcare	$18 - $234	56%
Fl Community Care Ltc	$19	59%
Humana	$19 - $42	59%
Sunshine Health	$19	59%
Wellcare	$19 - $43	59%
Simply Healthcare Healthy Kids	$21	65%
Pensacola	$25	77%
Uwf Athletes	$27 - $109	83%
Hospice Covenant	$41	127%
Medicare (plans)	$43	133%
Hospice Regency	$50	154%
Fl Blue	$68 - $308	210%
Cigna	$80 - $168	247%
Hospice Emerald Coast	$84	259%
Private Healthcare	$109	336%
First Health	$117	361%
Wc Corvel	$120 - $160	370%
Choicecare	$126	389%
Multiplan	$150	463%
Bc Fl	$201	620%

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 $25.
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 Gulf Breeze 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.