CMS Price Transparency Data

Occupational therapy (self-care training)

Facility: University of Iowa Hospital & Clinics

Billing Code: 97535 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97535
Insurance Median: $127
Cash Discount Price: $156
vs. Medicare Baseline: 3.92x Medicare

The contracted insurance negotiated median rate for a Occupational therapy (self-care training) at University of Iowa Hospital & Clinics is $127. 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 $32.4, this hospital’s rate is 3.92x the Medicare baseline. Located in 200 Hawkins Drive, Iowa City, IA.

Cash / Self-Pay

$156

Average discount available for prompt cash payment at this facility.

Insurance Median

$127

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: $156 (481%)

Insurance Median: $127 (392%)

Cash: $156 (481% of Medicare)

Ins. Median: $127 (392% 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.

Elevated Commercial Rate Alert (Value-Gap)

The negotiated rate at this facility is 392% of the Medicare baseline (a markup of 292%). 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	$28 - $32	86%
Molina Healthcare	$28 - $30	86%
Wellpoint (Amerigroup)	$28 - $32	86%
Aetna	$30 - $172	93%
Medical Associates	$30 - $149	93%
UnitedHealthcare	$30 - $169	93%
Blue Cross Blue Shield	$31 - $107	96%
Healthpartners	$31 - $190	96%
American Health Plan	$32 - $112	99%
Immergrun	$36 - $56	111%
Quad City Community Healthcare	$53 - $167	164%
Aplos Health Plan	$77 - $178	238%
Midlands Choice	$86 - $145	265%
Oscar Health	$91 - $140	281%
Great River Health Systems	$101 - $156	312%
Sedgwick	$115 - $178	355%
Global Excel	$122 - $190	377%
Sanford Health Plan	$122 - $190	377%
Employee Benefit Systems	$127 - $201	392%
Sisco	$127 - $196	392%
Healthsmart	$130 - $201	401%
Hfn	$132 - $205	407%
Multiplan	$132 - $205	407%

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: 97535.

Insurance In-Network Protection Plan

Contact your insurance company to confirm University of Iowa Hospital & Clinics 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.