CMS Price Transparency Data

Orthotic fitting and training

Facility: Franciscan Health Michigan City

Billing Code: 97760 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97760
Insurance Median: $166
Cash Discount Price: $52
vs. Medicare Baseline: 3.60x Medicare

The contracted insurance negotiated median rate for a Orthotic fitting and training at Franciscan Health Michigan City is $166. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $52. Compared to the federal Medicare reimbursement reference rate of $46.09, this hospital’s rate is 3.60x the Medicare baseline. Located in 3500 Franciscan Way, Michigan City, IN.

Cash / Self-Pay

$52

Average discount available for prompt cash payment at this facility.

Insurance Median

$166

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$46.09

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $46.09 (100%)

Cash / Self-Pay: $52 (113%)

Insurance Median: $166 (360%)

Cash: $52 (113% of Medicare)

Ins. Median: $166 (360% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $46.09 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 360% of the Medicare baseline (a markup of 260%). 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	11%
Medicare (plans)	$44	95%
Blue Cross Blue Shield	$84 - $138	182%
Aetna	$87	189%
Managed Care [2000]	$87 - $260	189%
Unicare [1150]	$87 - $88	189%
Workers Comp [1172]	$88	191%
Cigna	$101 - $194	219%
Commercial [2001]	$101 - $277	219%
Great West Insurance [1055]	$101 - $167	219%
Mdwise [1175]	$186	404%
Medicaid / KanCare	$186 - $224	404%
Managed Health Services [1302]	$192	417%
United Medical Resources [1158]	$237	514%
United Medical Resources [1301]	$237 - $260	514%
UnitedHealthcare	$237 - $260	514%

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 $52.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 97760.

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 97760.
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.