CMS Price Transparency Data

Occupational therapy (self-care training)

Facility: Ochsner LSU Health Monroe

Billing Code: 97535 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97535
Insurance Median: $49
Cash Discount Price: $19
vs. Medicare Baseline: 1.51x Medicare

The contracted insurance negotiated median rate for a Occupational therapy (self-care training) at Ochsner LSU Health Monroe is $49. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $19. Compared to the federal Medicare reimbursement reference rate of $32.4, this hospital’s rate is 1.51x the Medicare baseline. Located in 4864 Jackson Street, Monroe, LA.

Cash / Self-Pay

$19

Average discount available for prompt cash payment at this facility.

Insurance Median

$49

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: $19 (59%)

Insurance Median: $49 (151%)

Cash: $19 (59% of Medicare)

Ins. Median: $49 (151% 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.

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
Verity Health Network – Lsu First Choice	$28 - $42	86%
Humana	$29 - $30	90%
(Healthy Louisiana) And Healthy Blue Dual Advantage (Hmo-D-Snp)	$30	93%
Aetna	$30 - $70	93%
Blue Cross Blue Shield	$30 - $60	93%
Medicare (plans)	$30	93%
UnitedHealthcare	$30 - $156	93%
Vantage Health Plan - Commercial	$33	102%
Multiplan/Phcs/American Lifecare	$46 - $70	142%
Zelis	$48	148%
Usa Managed Care Network	$49 - $75	151%
Healthcomp Ppo (Formerly Gilsbar 360	$75	231%
First Health Network	$88	272%
Cigna	$114	352%

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 $19.
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 Ochsner LSU Health Monroe 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.