CMS Price Transparency Data

Occupational therapy (self-care training)

Facility: Lake Charles Memorial Hospital

Billing Code: 97535 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97535
Insurance Median: $43
Cash Discount Price: $56
vs. Medicare Baseline: 1.33x Medicare

The contracted insurance negotiated median rate for a Occupational therapy (self-care training) at Lake Charles Memorial Hospital is $43. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $56. Compared to the federal Medicare reimbursement reference rate of $32.4, this hospital’s rate is 1.33x the Medicare baseline. Located in 1701 Oak Park Blvd, Lake Charles, LA.

Cash / Self-Pay

$56

Average discount available for prompt cash payment at this facility.

Insurance Median

$43

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: $56 (173%)

Insurance Median: $43 (133%)

Cash: $56 (173% of Medicare)

Ins. Median: $43 (133% 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
Aetna	$14 - $110	43%
Medicaid / KanCare	$14 - $17	43%
Blue Cross Blue Shield	$31	96%
Champus_Va	$31	96%
Cigna	$31 - $74	96%
Medicare (plans)	$31	96%
Tricare	$31	96%
Veterans_Administration	$31	96%
Veterans_Choice-Triwest	$31	96%
Humana	$32 - $109	99%
Meritain	$39 - $45	120%
Verity	$42 - $48	130%
Ppo_Plus_	$52 - $59	160%
Coushatta_Tribe_Dept_Of_Health	$56	173%
Phcs	$61 - $69	188%
United_Healthcare_Behavorial_Health	$61 - $69	188%
Lwcc	$66 - $76	204%
First_Health	$69 - $79	213%
Blue_Cross_Blue_Shield_La	$71	219%
Vantage_Commercial	$71	219%
Workers_Compensation	$78 - $89	241%
United_Healthcare	$191	590%

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 $56.
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 Lake Charles Memorial Hospital 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.