CMS Price Transparency Data

Occupational therapy (therapeutic activities)

Facility: Boone County Hospital

Billing Code: 97530 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97530
Insurance Median: $52
Cash Discount Price: $96
vs. Medicare Baseline: 1.48x Medicare

The contracted insurance negotiated median rate for a Occupational therapy (therapeutic activities) at Boone County Hospital is $52. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $96. Compared to the federal Medicare reimbursement reference rate of $35.07, this hospital’s rate is 1.48x the Medicare baseline. Located in 1015 Union Street, Boone, IA.

Cash / Self-Pay

$96

Average discount available for prompt cash payment at this facility.

Insurance Median

$52

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: $96 (274%)

Insurance Median: $52 (148%)

Cash: $96 (274% of Medicare)

Ins. Median: $52 (148% 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.

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
Humana	$27 - $113	77%
Iowa Total Care Mcaid - All Plans	$31 - $58	88%
Meridian Mcaid - All Plans	$31 - $57	88%
Medicaid / KanCare	$32 - $58	91%
UnitedHealthcare	$32 - $74	91%
Choice Care Mcr Adv - All Plans	$33 - $52	94%
Iowa Hlth Adv - All Plans	$33 - $52	94%
Mt Carmel Hp - All Plans	$33 - $52	94%
Tricare	$33 - $50	94%
Va Ccn-All Plans	$33 - $52	94%
Aetna	$34 - $60	97%
Amerigroup Mcr Adv - All Other Plans	$34 - $52	97%
Healthsmart Accell Network	$34 - $88	97%
Healthsmart Ppo - All Other Plans	$35 - $101	100%
Health Alliance-All Plans	$40 - $113	114%
Health Partners Profee Only - All Plans	$45	128%
Medical Associates Hp-All Plans	$45 - $95	128%
Midlands Choice-All Plans	$48 - $116	137%
Wellmark Hmo	$54 - $106	154%
Wellmark Ppo - All Other Plans	$54 - $116	154%
Mutually Preferred-All Plans	$108 - $120	308%

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 $96.
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 Boone County 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.