CMS Price Transparency Data

Group therapy session

Facility: Ochsner Medical Center Acute

Billing Code: 90853 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 90853
Insurance Median: $85
Cash Discount Price: $72
vs. Medicare Baseline: 0.82x Medicare

The contracted insurance negotiated median rate for a Group therapy session at Ochsner Medical Center Acute is $85. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $72. Compared to the federal Medicare reimbursement reference rate of $103.79, this hospital’s rate is 0.82x the Medicare baseline. Located in 1516 Jefferson Hwy, New Orleans, LA.

Cash / Self-Pay

$72

Average discount available for prompt cash payment at this facility.

Insurance Median

$85

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$103.79

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $103.79 (100%)

Cash / Self-Pay: $72 (69%)

Insurance Median: $85 (82%)

Cash: $72 (69% of Medicare)

Ins. Median: $85 (82% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $103.79 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
Tricare	$33 - $85	32%
Aetna	$43 - $177	41%
Cigna	$56 - $214	54%
First Health Network	$64 - $245	62%
Louisiana Workers' Compensation Corporation (Lwcc)	$64 - $245	62%
Mississippi Physicians Care Network	$64 - $245	62%
Medicaid / KanCare	$66 - $69	64%
Healthcomp & Personify Health (Formerly Gilsbar)	$68 - $258	66%
Claritev D/B/A Multiplan/Phcs/American Life Care	$69 - $262	66%
Zelis	$69 - $262	66%
Employers Health Network (Ehn)	$73 - $278	70%
Prime Health Services Ppo	$73 - $278	70%
Usa Managed Care Network	$73 - $278	70%
Behavioral Health Systems	$77 - $294	74%
Evolutions Healthcare	$77 - $294	74%
Galaxy Health Network Ppo	$77 - $294	74%
Galaxy Health Network Wc	$77 - $294	74%
American Health Advantage Of Louisiana (Formerly Dignity Health Plan)	$85	82%
Blue Cross Blue Shield	$85 - $342	82%
Healthy Blue Dual Advantage (Hmo-D-Snp)	$85	82%
Humana	$85	82%
Medicare (plans)	$85	82%
Ochsner Health Plan	$85	82%
UnitedHealthcare	$85 - $275	82%
Pace New Orleans	$93	90%
Christus Health Exchange Plan	$148	143%

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 $72.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 90853.

Insurance In-Network Protection Plan

Contact your insurance company to confirm Ochsner Medical Center Acute is fully in-network.
Ask your insurer if "Prior Authorization" is required for CPT code 90853.
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.