CMS Price Transparency Data

Occupational therapy (therapeutic activities)

Facility: Mercyone Waterloo Medical Center

Billing Code: 97530 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97530
Insurance Median: $111
Cash Discount Price: $1,049
vs. Medicare Baseline: 3.17x Medicare

The contracted insurance negotiated median rate for a Occupational therapy (therapeutic activities) at Mercyone Waterloo Medical Center is $111. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,049. Compared to the federal Medicare reimbursement reference rate of $35.07, this hospital’s rate is 3.17x the Medicare baseline. Located in 3421 West Ninth Street, Waterloo, IA.

Cash / Self-Pay

$1,049

Average discount available for prompt cash payment at this facility.

Insurance Median

$111

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: $1,049 (2991%)

Insurance Median: $111 (317%)

Cash: $1,049 (2991% of Medicare)

Ins. Median: $111 (317% 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 317% of the Medicare baseline (a markup of 217%). 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	88%
Medicaid / KanCare	$32	91%
Aetna	$33 - $302	94%
Amish Hospital Aid	$33	94%
Blue Cross Blue Shield	$33	94%
Medicare (plans)	$33 - $34	94%
UnitedHealthcare	$33 - $292	94%
Health Choices	$37 - $69	106%
Medical Associates	$37 - $69	106%
Oscar	$51	145%
Centivo	$55	157%
Ambetter / Centene	$56	160%
Claimdoc	$67	191%
Nova	$67	191%
Health Partners	$102 - $192	291%
Auxiant	$111 - $207	317%
Cigna	$111 - $207	317%
Medica	$111 - $207	317%
Midlands	$111 - $207	317%
Midlands Choice	$111 - $207	317%
Iowa Dept Of Public Health	$156 - $292	445%
Geha	$231	659%
Allied Benefit Systems	$302	861%
Asr Health Benefits	$302	861%
Christian Brother Services	$302	861%
Coventry	$302	861%
First Health	$302	861%
Lucent Health	$302	861%
Luminare Health	$302	861%
Medical Mutual	$302	861%
Meritain	$302	861%
Webtpa	$302	861%

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 $1,049.
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 Mercyone Waterloo Medical Center 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.