CMS Price Transparency Data

Occupational therapy (therapeutic activities)

Facility: University of Iowa Health Care Medical Center Down

Billing Code: 97530 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97530
Insurance Median: $144
Cash Discount Price: $156
vs. Medicare Baseline: 4.11x Medicare

The contracted insurance negotiated median rate for a Occupational therapy (therapeutic activities) at University of Iowa Health Care Medical Center Down is $144. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $156. Compared to the federal Medicare reimbursement reference rate of $35.07, this hospital’s rate is 4.11x the Medicare baseline. Located in 500 E Market Street, Iowa City, IA.

Cash / Self-Pay

$156

Average discount available for prompt cash payment at this facility.

Insurance Median

$144

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: $156 (445%)

Insurance Median: $144 (411%)

Cash: $156 (445% of Medicare)

Ins. Median: $144 (411% 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.

Elevated Commercial Rate Alert (Value-Gap)

The negotiated rate at this facility is 411% of the Medicare baseline (a markup of 311%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.

Consult Patient Advocate

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
Iowa Total Care	$31 - $34	88%
Molina Healthcare	$31 - $33	88%
Wellpoint (Amerigroup)	$31 - $34	88%
Aetna	$33 - $225	94%
Blue Cross Blue Shield	$33 - $118	94%
Healthpartners	$33 - $208	94%
Medical Associates	$33 - $164	94%
UnitedHealthcare	$33 - $186	94%
Immergrun	$40 - $61	114%
Quad City Community Healthcare	$53 - $184	151%
Midlands Choice	$84 - $159	240%
Aplos Health Plan	$86 - $196	245%
Oscar Health	$101 - $154	288%
Great River Health Systems	$112 - $172	319%
Sedgwick	$128 - $196	365%
Global Excel	$136 - $208	388%
Sanford Health Plan	$136 - $208	388%
Employee Benefit Systems	$141 - $220	402%
Sisco	$141 - $216	402%
Healthsmart	$144 - $220	411%
Hfn	$147 - $225	419%
Multiplan	$147 - $225	419%

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 $156.
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 University of Iowa Health Care Medical Center Down 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.