CMS Price Transparency Data

Occupational therapy (therapeutic activities)

Facility: Audubon County Memorial Hospital

Billing Code: 97530 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97530
Insurance Median: $103
Cash Discount Price: $118
vs. Medicare Baseline: 2.94x Medicare

The contracted insurance negotiated median rate for a Occupational therapy (therapeutic activities) at Audubon County Memorial Hospital is $103. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $118. Compared to the federal Medicare reimbursement reference rate of $35.07, this hospital’s rate is 2.94x the Medicare baseline. Located in 515 Pacific Avenue, Audubon, IA.

Cash / Self-Pay

$118

Average discount available for prompt cash payment at this facility.

Insurance Median

$103

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: $118 (336%)

Insurance Median: $103 (294%)

Cash: $118 (336% of Medicare)

Ins. Median: $103 (294% 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 294% of the Medicare baseline (a markup of 194%). 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
Aetna	$72 - $122	205%
Tricare	$72 - $97	205%
UnitedHealthcare	$85 - $115	242%
Midlands Choice - All Plans	$98 - $132	279%
Molina Mcaid - All Plans	$100 - $135	285%
Iowa Total Care Mcaid - All Plans	$101 - $136	288%
Amerigroup Mcaid - All Plans	$105 - $142	299%
Wellmark Hmo	$150	428%
Wellmark Ppo - All Other Plans	$166	473%

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 $118.
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 Audubon County Memorial 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.