CMS Price Transparency Data

Occupational therapy (therapeutic activities)

Facility: Mercyone Dyersville Medical Center

Billing Code: 97530 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97530
Insurance Median: $164
Cash Discount Price: $129
vs. Medicare Baseline: 4.68x Medicare

The contracted insurance negotiated median rate for a Occupational therapy (therapeutic activities) at Mercyone Dyersville Medical Center is $164. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $129. Compared to the federal Medicare reimbursement reference rate of $35.07, this hospital’s rate is 4.68x the Medicare baseline. Located in 1111 3Rd Street Sw, Dyersville, IA.

Cash / Self-Pay

$129

Average discount available for prompt cash payment at this facility.

Insurance Median

$164

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: $129 (368%)

Insurance Median: $164 (468%)

Cash: $129 (368% of Medicare)

Ins. Median: $164 (468% 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 468% of the Medicare baseline (a markup of 368%). 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	$75	214%
Blue Cross Blue Shield	$110	314%
Medicare (plans)	$112 - $122	319%
UnitedHealthcare	$118 - $178	336%
The Alliance	$120	342%
Iowa Total Care	$137	391%
Medicaid / KanCare	$139 - $140	396%
Amish Hospital Aid	$147	419%
1199 National Benefit Fund	$164	468%
Aetna	$164	468%
Allied Benefit Systems	$164	468%
Asr Health Benefits	$164	468%
Christian Brother Services	$164	468%
Coventry	$164	468%
First Health	$164	468%
Luminare Health	$164	468%
Medical Mutual	$164	468%
Meritain	$164	468%
Trustmark Small Business Benefits	$164	468%
Webtpa	$164	468%
Auxiant	$178	508%
Cigna	$178	508%
Geha	$178	508%
Medica	$178	508%
Midlands	$178	508%
Midlands Choice	$178	508%
Multiplan	$178	508%
Ambetter / Centene	$186	530%
Crime Victim Assistance	$198	565%
Iowa Dept Of Public Health	$198	565%
Claimdoc	$223	636%
Nova	$223	636%

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 $129.
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 Dyersville 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.