CMS Price Transparency Data

Occupational therapy (therapeutic activities)

Facility: Ochsner Medical Center Acute

Billing Code: 97530 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97530
Insurance Median: $111
Cash Discount Price: $41
vs. Medicare Baseline: 3.17x Medicare

The contracted insurance negotiated median rate for a Occupational therapy (therapeutic activities) at Ochsner Medical Center Acute is $111. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $41. Compared to the federal Medicare reimbursement reference rate of $35.07, this hospital’s rate is 3.17x the Medicare baseline. Located in 1516 Jefferson Hwy, New Orleans, LA.

Cash / Self-Pay

$41

Average discount available for prompt cash payment at this facility.

Insurance Median

$111

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: $41 (117%)

Insurance Median: $111 (317%)

Cash: $41 (117% of Medicare)

Ins. Median: $111 (317% 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 317% of the Medicare baseline (a markup of 217%). 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
Aetna	$9 - $113	26%
Amerihealth Caritas Louisiana (Healthy Louisiana)	$9	26%
Healthy Blue (Healthy Louisiana)	$9	26%
Humana	$9	26%
Louisiana Healthcare Connections (Healthy Louisiana)	$9	26%
UnitedHealthcare	$9 - $300	26%
Medicaid / KanCare	$30 - $31	86%
Tricare	$31 - $35	88%
Christus Health Exchange Plan	$86	245%
American Health Advantage Of Louisiana (Formerly Dignity Health Plan)	$92	262%
Blue Cross Blue Shield	$92 - $114	262%
Healthy Blue Dual Advantage (Hmo-D-Snp)	$92	262%
Ochsner Health Plan	$92	262%
First Health Network	$139	396%
Louisiana Workers' Compensation Corporation (Lwcc)	$139	396%
Mississippi Physicians Care Network	$139	396%
Healthcomp & Personify Health (Formerly Gilsbar)	$146	416%
Claritev D/B/A Multiplan/Phcs/American Life Care	$148	422%
Zelis	$148	422%
Employers Health Network (Ehn)	$157	448%
Prime Health Services Ppo	$157	448%
Usa Managed Care Network	$157	448%
Behavioral Health Systems	$166	473%
Evolutions Healthcare	$166	473%
Galaxy Health Network Ppo	$166	473%
Galaxy Health Network Wc	$166	473%
Cigna	$441	1257%

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 $41.
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 Ochsner Medical Center Acute 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.