CMS Price Transparency Data
Prosthetic fitting and training
Facility: St Joe Mercy Hospital System Livonia
Billing Code: 97761 (CPT)
Factual Cost Summary (Answer Capsule)
- CPT Billing Code: 97761
- Insurance Median: $114
- Cash Discount Price: $118
- vs. Medicare Baseline: 2.82x Medicare
The contracted insurance negotiated median rate for a Prosthetic fitting and training at St Joe Mercy Hospital System Livonia is $114. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $118. Compared to the federal Medicare reimbursement reference rate of $40.41, this hospital’s rate is 2.82x the Medicare baseline. Located in 36475 Five Mile Road, Livonia, MI.
Cash / Self-Pay
$118
Average discount available for prompt cash payment at this facility.
Insurance Median
$114
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: $118 (292%)
Insurance Median: $114 (282%)
Cash: $118 (292% of Medicare)
Ins. Median: $114 (282% 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 282% of the Medicare baseline (a markup of 182%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.
Out-of-Pocket Cost Estimator
Estimate whether it is more economical to use your insurance or pay the upfront self-pay cash 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 |
|---|---|---|
| Blue Cross Blue Shield | $22 - $56 | 54% |
| Medicaid / KanCare | $22 | 54% |
| Aetna | $39 - $105 | 97% |
| Blue Care Network Advantage | $39 | 97% |
| Hospice Of Michigan | $39 | 97% |
| Medicare (plans) | $39 - $42 | 97% |
| Align Senior Care | $40 | 99% |
| Angela Hospice | $40 | 99% |
| UnitedHealthcare | $41 - $116 | 101% |
| Cca - Zing Health | $42 | 104% |
| Longevity Ipa Of Michigan Llc Health Plan Isnp | $45 | 111% |
| Wc Accident Fund | $51 | 126% |
| Wc Advantage | $51 | 126% |
| Wc Aig | $51 | 126% |
| Wc Allied | $51 | 126% |
| Wc Amerisure | $51 | 126% |
| Wc Amtrust | $51 | 126% |
| Wc Asu Risk Mgt | $51 | 126% |
| Wc Berkley Admin | $51 | 126% |
| Wc Broadspire | $51 | 126% |
| Wc Bunch & Associates | $51 | 126% |
| Wc Ccmsi | $51 | 126% |
| Wc Emc Insurance Company | $51 | 126% |
| Wc Esis | $51 | 126% |
| Wc Fcci | $51 | 126% |
| Wc Federated | $51 | 126% |
| Wc Gallagher Bassett | $51 | 126% |
| Wc Genex Care For Ohio | $51 | 126% |
| Wc Guard Insurance Company | $51 | 126% |
| Wc Hartford | $51 | 126% |
| Wc Liberty Mutual | $51 | 126% |
| Wc Meijers | $51 | 126% |
| Wc Michigan | $51 | 126% |
| Wc Mitchell Frankenmuth | $51 | 126% |
| Wc Pma | $51 | 126% |
| Wc Sedgwick | $51 | 126% |
| Wc Sentry | $51 | 126% |
| Wc Travelers | $51 | 126% |
| Wc Tristar | $51 | 126% |
| Wc Walmart | $51 | 126% |
| Wc Zurich | $51 | 126% |
| Molina Marketplace | $52 | 129% |
| Bcn Domestic | $56 | 139% |
| Blue Benefit Administrators Of Massachusetts | $56 | 139% |
| Blue Care Network | $56 | 139% |
| Blue Distinction Transplant | $56 | 139% |
| Blue Shield - Ca | $56 | 139% |
| Blue Shield - Id (Regence) | $56 | 139% |
| Blue Shield - Ny Highmark Northeastern | $56 | 139% |
| Blue Shield - Ny Highmark Western | $56 | 139% |
| Blue Shield - Pa (Highmark) | $56 | 139% |
| Blue Shield - Wa (Regence) | $56 | 139% |
| Health Choices | $56 - $115 | 139% |
| Kaiser Domestic | $56 | 139% |
| Priority Health | $58 - $64 | 144% |
| Health Cost Solutions | $62 | 153% |
| U Of M Health Plan | $62 | 153% |
| Vitalcore | $62 | 153% |
| Wellpath | $62 | 153% |
| Acs Benefit Services | $77 | 191% |
| Allied Benefit Systems | $77 | 191% |
| Claimchoice Adminstrators | $77 | 191% |
| Consociate | $77 | 191% |
| Cypress Benefit Administrators | $77 | 191% |
| Forest County Potawatomi | $77 | 191% |
| Health Smart | $77 | 191% |
| Healthgram | $77 | 191% |
| Healthscope | $77 | 191% |
| Secureone Preferred United Plans | $77 | 191% |
| Sisco Benefits | $77 | 191% |
| The Health Plan | $77 | 191% |
| Trustmark Small Business Benefits | $77 | 191% |
| Unified Group Services | $77 | 191% |
| Webtpa | $77 | 191% |
| Employee Benefit Logistic | $90 | 223% |
| Asr Health Benefits | $93 | 230% |
| Caresource | $93 | 230% |
| Hap | $93 - $111 | 230% |
| Varipro | $93 | 230% |
| Geha | $105 - $116 | 260% |
| Luminare Health (Detroit) | $105 | 260% |
| Meritain | $105 | 260% |
| Health Partners | $111 | 275% |
| Tufts Health Plan | $111 | 275% |
| Cigna | $113 - $145 | 280% |
| Access Health | $115 | 285% |
| Acclaim | $115 | 285% |
| Administrative Concepts | $115 | 285% |
| Allegeant | $115 | 285% |
| Ameriben | $115 | 285% |
| American Family | $115 | 285% |
| American Healthcare Alliance | $115 | 285% |
| American National | $115 | 285% |
| American Republic | $115 | 285% |
| Amerihealth | $115 | 285% |
| Aultcare | $115 | 285% |
| Automated Benefit Services | $115 | 285% |
| Auxiant | $115 | 285% |
| Benefit Administrative Systems,Llc | $115 | 285% |
| Boon Chapman | $115 | 285% |
| Cam Administrative Services | $115 | 285% |
| Christian Brother Services | $115 | 285% |
| Christian Brothers Holy Cross | $115 | 285% |
| Comprehensive Benefits | $115 | 285% |
| Continental Life Insurance | $115 | 285% |
| Custom Benefit Administrators | $115 | 285% |
| Employee Benefit Concepts | $115 | 285% |
| Employee Benefit Management | $115 | 285% |
| Enterprise Group Planning | $115 | 285% |
| Freedom Life Insurance Company | $115 | 285% |
| Group Administrators | $115 | 285% |
| Group Marketing Services | $115 | 285% |
| Guardian | $115 | 285% |
| Health America | $115 | 285% |
| Healthcare Management Admin | $115 | 285% |
| Healthez | $115 | 285% |
| Humana | $115 | 285% |
| Insight | $115 | 285% |
| Intercare | $115 | 285% |
| Jfp Benefit Management | $115 | 285% |
| Jp Farley Corporation | $115 | 285% |
| Key Benefit Administrator | $115 | 285% |
| Liberty Union Life Assurance Co | $115 | 285% |
| Lucent Health | $115 | 285% |
| Luminare Health | $115 | 285% |
| Magnacare | $115 | 285% |
| Medben | $115 | 285% |
| Medcost | $115 | 285% |
| Medical Mutual | $115 | 285% |
| Mutual Health Services | $115 | 285% |
| Mutual Of Omaha | $115 | 285% |
| Ncas | $115 | 285% |
| Nippon Life Ins | $115 | 285% |
| Nova | $115 | 285% |
| Painters Union Insurance Fund | $115 | 285% |
| Physicians Mutual | $115 | 285% |
| Plumbers Local 98 Insurance Fund | $115 | 285% |
| Prairie States | $115 | 285% |
| Preferred One | $115 | 285% |
| Primary Physician Care | $115 | 285% |
| Professional Benefit Administrators | $115 | 285% |
| Siho Insurance Services | $115 | 285% |
| The Loomis Company | $115 | 285% |
| Unicare | $115 | 285% |
| Us Health And Life | $115 | 285% |
| Valenz | $115 | 285% |
| Western & Southern Financial Group | $115 | 285% |
| Wps | $115 | 285% |
| 1199 National Benefit Fund | $116 | 287% |
| Allied National Global Care | $116 | 287% |
| Asrm - Reliance Standard Life Insurance | $116 | 287% |
| Christian Care Ministry | $116 | 287% |
| Dean Health | $116 | 287% |
| Fallon Health | $116 | 287% |
| Family Life Insurance Company | $116 | 287% |
| Ghc Scw | $116 | 287% |
| Group Pension Administrators | $116 | 287% |
| International Benefit Administrators | $116 | 287% |
| Lifetime Benefit Solutions | $116 | 287% |
| Manhattan Life | $116 | 287% |
| Medi Share | $116 | 287% |
| Multiplan | $116 | 287% |
| Mvp | $116 | 287% |
| Pai | $116 | 287% |
| Pan-American Life | $116 | 287% |
| Paramount Hmo | $116 | 287% |
| Phcs | $116 | 287% |
| Trinity Health Share | $116 | 287% |
| First Health | $118 | 292% |
| Coventry | $145 | 359% |
| Prime Health Services | $145 | 359% |
| Three Rivers Provider Network | $163 | 403% |
| Carelon Behavioral Health | $181 | 448% |
| Cmh Detroit Wayne Integrated Health Network | $181 | 448% |
| Cmh Lenawee County | $181 | 448% |
| Cmh Livingston County | $181 | 448% |
| Cmh Misc | $181 | 448% |
| Cmh Monroe County | $181 | 448% |
| Cmh Washtenaw County | $181 | 448% |
| Magellan Behavioral Health | $181 | 448% |