CMS Price Transparency Data

Occupational therapy (therapeutic activities)

Facility: Franciscan Health Michigan City

Billing Code: 97530 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97530
Insurance Median: $149
Cash Discount Price: $42
vs. Medicare Baseline: 4.25x Medicare

The contracted insurance negotiated median rate for a Occupational therapy (therapeutic activities) at Franciscan Health Michigan City is $149. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $42. Compared to the federal Medicare reimbursement reference rate of $35.07, this hospital’s rate is 4.25x the Medicare baseline. Located in 3500 Franciscan Way, Michigan City, IN.

Cash / Self-Pay

$42

Average discount available for prompt cash payment at this facility.

Insurance Median

$149

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: $42 (120%)

Insurance Median: $149 (425%)

Cash: $42 (120% of Medicare)

Ins. Median: $149 (425% 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 425% of the Medicare baseline (a markup of 325%). 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
Research/Grant [2012]	$5	14%
Medicare (plans)	$34	97%
Aetna	$66	188%
Blue Cross Blue Shield	$66 - $124	188%
Managed Care [2000]	$66 - $260	188%
Unicare [1150]	$66 - $67	188%
Workers Comp [1172]	$67	191%
Cigna	$92 - $174	262%
Commercial [2001]	$92 - $249	262%
Great West Insurance [1055]	$92 - $150	262%
Mdwise [1175]	$186	530%
Medicaid / KanCare	$186 - $224	530%
Managed Health Services [1302]	$192	547%
United Medical Resources [1158]	$237	676%
United Medical Resources [1301]	$237 - $260	676%
UnitedHealthcare	$237 - $260	676%

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 $42.
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 Franciscan Health Michigan City 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.