CMS Price Transparency Data

Total knee replacement

Facility: Franciscan Health Michigan City

Billing Code: 27447 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 27447
Insurance Median: $32,085
Cash Discount Price: $16,454
vs. Medicare Baseline: 2.45x Medicare

The contracted insurance negotiated median rate for a Total knee replacement at Franciscan Health Michigan City is $32,085. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $16,454. Compared to the federal Medicare reimbursement reference rate of $13,116.76, this hospital’s rate is 2.45x the Medicare baseline. Located in 3500 Franciscan Way, Michigan City, IN.

Cash / Self-Pay

$16,454

Average discount available for prompt cash payment at this facility.

Insurance Median

$32,085

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$13,116.76

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $13,116.76 (100%)

Cash / Self-Pay: $16,454 (125%)

Insurance Median: $32,085 (245%)

Cash: $16,454 (125% of Medicare)

Ins. Median: $32,085 (245% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $13,116.76 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 245% of the Medicare baseline (a markup of 145%). 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
Medicare (plans)	$13,583	104%
Mdwise [1175]	$26,103	199%
Medicaid / KanCare	$26,103 - $31,324	199%
Managed Health Services [1302]	$26,907	205%
Workers Comp [1172]	$27,167	207%
Blue Cross Blue Shield	$32,847 - $46,841	250%
Unicare [1150]	$46,841	357%
Commercial [2001]	$49,765	379%
Managed Care [2000]	$49,765	379%

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 $16,454.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 27447.

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 27447.
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.