CMS Price Transparency Data

Prosthetic fitting and training

Facility: Franciscan Health Michigan City

Billing Code: 97761 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97761
Insurance Median: $158
Cash Discount Price: $45
vs. Medicare Baseline: 3.91x Medicare

The contracted insurance negotiated median rate for a Prosthetic fitting and training at Franciscan Health Michigan City is $158. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $45. Compared to the federal Medicare reimbursement reference rate of $40.41, this hospital’s rate is 3.91x the Medicare baseline. Located in 3500 Franciscan Way, Michigan City, IN.

Cash / Self-Pay

$45

Average discount available for prompt cash payment at this facility.

Insurance Median

$158

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$40.41

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $40.41 (100%)

Cash / Self-Pay: $45 (111%)

Insurance Median: $158 (391%)

Cash: $45 (111% of Medicare)

Ins. Median: $158 (391% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $40.41 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 391% of the Medicare baseline (a markup of 291%). 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	12%
Medicare (plans)	$39	97%
Aetna	$77	191%
Blue Cross Blue Shield	$77 - $132	191%
Managed Care [2000]	$77 - $260	191%
Unicare [1150]	$77	191%
Workers Comp [1172]	$77	191%
Cigna	$103 - $185	255%
Commercial [2001]	$103 - $264	255%
Great West Insurance [1055]	$103 - $159	255%
Mdwise [1175]	$186	460%
Medicaid / KanCare	$186 - $224	460%
Managed Health Services [1302]	$192	475%
United Medical Resources [1158]	$237	586%
United Medical Resources [1301]	$237 - $260	586%
UnitedHealthcare	$237 - $260	586%

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 $45.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 97761.

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 97761.
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.