CMS Price Transparency Data

Occupational therapy (self-care training)

Facility: Mercyone Dyersville Medical Center

Billing Code: 97535 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97535
Insurance Median: $119
Cash Discount Price: $94
vs. Medicare Baseline: 3.67x Medicare

The contracted insurance negotiated median rate for a Occupational therapy (self-care training) at Mercyone Dyersville Medical Center is $119. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $94. Compared to the federal Medicare reimbursement reference rate of $32.4, this hospital’s rate is 3.67x the Medicare baseline. Located in 1111 3Rd Street Sw, Dyersville, IA.

Cash / Self-Pay

$94

Average discount available for prompt cash payment at this facility.

Insurance Median

$119

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: $94 (290%)

Insurance Median: $119 (367%)

Cash: $94 (290% of Medicare)

Ins. Median: $119 (367% 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 367% of the Medicare baseline (a markup of 267%). 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
Health Choices	$54	167%
Blue Cross Blue Shield	$80	247%
Medicare (plans)	$81 - $89	250%
UnitedHealthcare	$85 - $130	262%
The Alliance	$88	272%
Iowa Total Care	$100	309%
Medicaid / KanCare	$101 - $102	312%
Amish Hospital Aid	$107	330%
1199 National Benefit Fund	$119	367%
Aetna	$119	367%
Allied Benefit Systems	$119	367%
Asr Health Benefits	$119	367%
Christian Brother Services	$119	367%
Coventry	$119	367%
First Health	$119	367%
Luminare Health	$119	367%
Medical Mutual	$119	367%
Meritain	$119	367%
Trustmark Small Business Benefits	$119	367%
Webtpa	$119	367%
Auxiant	$130	401%
Cigna	$130	401%
Geha	$130	401%
Medica	$130	401%
Midlands	$130	401%
Midlands Choice	$130	401%
Multiplan	$130	401%
Ambetter / Centene	$135	417%
Crime Victim Assistance	$144	444%
Iowa Dept Of Public Health	$144	444%
Claimdoc	$162	500%
Nova	$162	500%

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 $94.
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 Mercyone Dyersville Medical Center 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.