CMS Price Transparency Data

Occupational therapy (therapeutic activities)

Facility: Spencer Municipal Hospital

Billing Code: 97530 (CPT)

The BaseRate · fair price high confidence

A fair price for this

$103

about 2.9× the $35 Medicare rate · typically $68–$132

modeled estimate · not a bill or quote

What this hospital charges insurers

$127

Above the fair price

about $24 over the fair price · 3.6× Medicare

Medicare pays $35 Fair price $103 This hospital $127 Cash price $125 Hospital's list price $166

How we calculate the fair BaseRate →

How this hospital compares to other IA hospitals

Highest price of the 9 IA hospitals we have prices for — worth calling around.

Cheapest $26 Priciest $127

Black dot = this hospital, among the 9 IA hospitals with a price for this procedure. Full list below.

A fair price for a Occupational therapy (therapeutic activities) is about $103 (about 2.9× the $35 Medicare rate). Spencer Municipal Hospital charges insurers about $127, or about $125 in cash — above the fair price. Located in Spencer, IA.

This price is above the fair BaseRate — you may be able to pay less

Ask the hospital for the cash / self-pay price, check whether you qualify for financial assistance, or negotiate the bill down toward the fair price of about $103. Many patients pay well below the first number they’re quoted — the checklists below walk you through it.

What each insurance company pays

Which insurers have negotiated a price with this hospital for this procedure — and which haven’t.

4 of 6 major insurers have a published price at this hospital

✓ UnitedHealthcare✓ Blue Cross Blue Shield✓ Aetna✓ Humana CignaKaiser Permanente

Crossed out = this hospital hasn’t published a negotiated price for that insurer for this procedure. It doesn’t necessarily mean they aren’t accepted — ask your insurer.

Insurance company	Price range	vs. Medicare
UnitedHealthcaremajor	$150	428%
Blue Cross Blue Shieldmajor	$121	345%
Aetnamajor	$150	428%
Humanamajor	$158	451%
HealthPartners	$133	379%
Sanford Health Plan	$158	451%
+ 2 smaller / regional plans	$158

Government programs also on file: Medicaid.

Excludes 5 rental-network / third-party entries (e.g. Multiplan, PHCS) — these are pricing networks, not insurers.

Self-Pay How to get the cash price

Tell the billing desk you want to be billed as self-pay — not through insurance — before your visit.
Ask for the cash / prompt-pay discount in writing, with the exact price (about 125), before you agree to anything.
Get it in writing that they won’t also bill your insurance, so the cash price is what you owe.
Check the CPT code on your bill matches exactly: 97530.

Insurance Before you use insurance

Call your insurance company to confirm Spencer Municipal Hospital is in-network.
Ask your insurer whether prior approval is required for CPT code 97530.
Confirm the doctor or provider is in-network too — not just the hospital building.
Check your Explanation of Benefits against the hospital’s final itemized bill.

Estimate your out-of-pocket cost

A rough estimate of what you’d pay with insurance (deductible + coinsurance) versus paying the cash price yourself.

How you’d pay

Deductible left to meet ($)

Your coinsurance (%)

Enter your details and press estimate to compare.

Other Procedures at Spencer Municipal Hospital

Compare: Occupational therapy (therapeutic activities) at other IA hospitals

Insurance negotiated median for the same procedure, sorted lowest first.