CMS Price Transparency Data

Occupational therapy (self-care training)

Facility: Monroe Surgical Hospital

Billing Code: 97535 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97535
Insurance Median: $43
Cash Discount Price: $74
vs. Medicare Baseline: 1.33x Medicare

The contracted insurance negotiated median rate for a Occupational therapy (self-care training) at Monroe Surgical Hospital is $43. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $74. Compared to the federal Medicare reimbursement reference rate of $32.4, this hospital’s rate is 1.33x the Medicare baseline. Located in 2408 Broadmoor Blvd, Monroe, LA.

Cash / Self-Pay

$74

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: $74 (228%)

Insurance Median: $43 (133%)

Cash: $74 (228% 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
Healthy_Blue	$13	40%
Medicaid / KanCare	$13	40%
Aetna	$30 - $69	93%
Blue_Cross_Blue_Shield	$30 - $48	93%
Ford_Bacon_And_Davis	$30	93%
Humana	$30 - $53	93%
Medicare (plans)	$30	93%
UnitedHealthcare	$30 - $156	93%
Vantage	$30 - $53	93%
Verity	$35	108%
Insurance_Systems_Smso_Employee	$38	117%
Insurance_Systems	$43	133%
Gilsbar	$65	201%
First_Health	$69	213%
Cigna	$74	228%
Ima	$79	244%
Beech_St	$84	259%
Workers_Comp	$89	275%

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 $74.
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 Monroe Surgical 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.