CMS Price Transparency Data

Occupational therapy (therapeutic activities)

Facility: Gulf Breeze Hospital

Billing Code: 97530 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97530
Insurance Median: $48
Cash Discount Price: $20
vs. Medicare Baseline: 1.37x Medicare

The contracted insurance negotiated median rate for a Occupational therapy (therapeutic activities) at Gulf Breeze Hospital is $48. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $20. Compared to the federal Medicare reimbursement reference rate of $35.07, this hospital’s rate is 1.37x the Medicare baseline. Located in 1110 Gulf Breeze Pkwy, Gulf Breeze, FL.

Cash / Self-Pay

$20

Average discount available for prompt cash payment at this facility.

Insurance Median

$48

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: $20 (57%)

Insurance Median: $48 (137%)

Cash: $20 (57% of Medicare)

Ins. Median: $48 (137% 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.

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	$15 - $151	43%
Pensacola	$20	57%
Cha Health Plan	$23	66%
UnitedHealthcare	$23 - $234	66%
Fl Community Care Ltc	$24	68%
Humana	$24 - $46	68%
Sunshine Health	$24	68%
Wellcare	$24 - $47	68%
Simply Healthcare Healthy Kids	$26	74%
Uwf Athletes	$27 - $86	77%
Hospice Regency	$40	114%
Hospice Covenant	$45	128%
Medicare (plans)	$48	137%
Cigna	$63 - $133	180%
Hospice Emerald Coast	$66	188%
Fl Blue	$75 - $308	214%
Private Healthcare	$86	245%
First Health	$92	262%
Wc Corvel	$95 - $126	271%
Choicecare	$100	285%
Multiplan	$118	336%
Bc Fl	$201	573%

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 $20.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 97530.

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 97530.
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.