CMS Price Transparency Data
Orthotic fitting and training
Facility: Trinity Health Oakland Hospital
Billing Code: 97760 (CPT)
Factual Cost Summary (Answer Capsule)
- CPT Billing Code: 97760
- Insurance Median: $139
- Cash Discount Price: $133
- vs. Medicare Baseline: 3.02x Medicare
The contracted insurance negotiated median rate for a Orthotic fitting and training at Trinity Health Oakland Hospital is $139. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $133. Compared to the federal Medicare reimbursement reference rate of $46.09, this hospital’s rate is 3.02x the Medicare baseline. Located in 44405 Woodward Ave, Pontiac, MI.
Cash / Self-Pay
$133
Average discount available for prompt cash payment at this facility.
Insurance Median
$139
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: $133 (289%)
Insurance Median: $139 (302%)
Cash: $133 (289% of Medicare)
Ins. Median: $139 (302% 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 302% of the Medicare baseline (a markup of 202%). 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 | $25 - $73 | 54% |
| Medicaid / KanCare | $25 | 54% |
| Aetna | $45 - $128 | 98% |
| Blue Care Network Advantage | $45 | 98% |
| Medicare (plans) | $45 - $46 | 98% |
| Align Senior Care | $46 | 100% |
| Hospice Advantage | $46 | 100% |
| UnitedHealthcare | $47 - $153 | 102% |
| Cca - Zing Health | $48 | 104% |
| Longevity Ipa Of Michigan Llc Health Plan Isnp | $51 | 111% |
| Molina Marketplace | $59 | 128% |
| Wc Accident Fund | $62 | 135% |
| Wc Advantage | $62 | 135% |
| Wc Aig | $62 | 135% |
| Wc Allied | $62 | 135% |
| Wc Amerisure | $62 | 135% |
| Wc Amtrust | $62 | 135% |
| Wc Asu Risk Mgt | $62 | 135% |
| Wc Berkley Admin | $62 | 135% |
| Wc Broadspire | $62 | 135% |
| Wc Bunch & Associates | $62 | 135% |
| Wc Ccmsi | $62 | 135% |
| Wc Emc Insurance Company | $62 | 135% |
| Wc Esis | $62 | 135% |
| Wc Fcci | $62 | 135% |
| Wc Federated | $62 | 135% |
| Wc Gallagher Bassett | $62 | 135% |
| Wc Genex Care For Ohio | $62 | 135% |
| Wc Guard Insurance Company | $62 | 135% |
| Wc Hartford | $62 | 135% |
| Wc Liberty Mutual | $62 | 135% |
| Wc Meijers | $62 | 135% |
| Wc Michigan | $62 | 135% |
| Wc Mitchell Frankenmuth | $62 | 135% |
| Wc Pma | $62 | 135% |
| Wc Sedgwick | $62 | 135% |
| Wc Sentry | $62 | 135% |
| Wc Travelers | $62 | 135% |
| Wc Tristar | $62 | 135% |
| Wc Walmart | $62 | 135% |
| Wc Zurich | $62 | 135% |
| U Of M Health Plan | $70 | 152% |
| Health Cost Solutions | $71 | 154% |
| Priority Health | $71 - $79 | 154% |
| Vitalcore | $71 | 154% |
| Wellpath | $71 | 154% |
| Bcn Domestic | $73 | 158% |
| Blue Benefit Administrators Of Massachusetts | $73 | 158% |
| Blue Care Network | $73 | 158% |
| Blue Distinction Transplant | $73 | 158% |
| Blue Shield - Ca | $73 | 158% |
| Blue Shield - Id (Regence) | $73 | 158% |
| Blue Shield - Ny Highmark Northeastern | $73 | 158% |
| Blue Shield - Ny Highmark Western | $73 | 158% |
| Blue Shield - Pa (Highmark) | $73 | 158% |
| Blue Shield - Wa (Regence) | $73 | 158% |
| Health Choices | $73 - $150 | 158% |
| Kaiser Domestic | $73 | 158% |
| Acs Benefit Services | $90 | 195% |
| Allied Benefit Systems | $90 | 195% |
| Asr Health Benefits | $90 | 195% |
| Caresource | $90 | 195% |
| Claimchoice Adminstrators | $90 | 195% |
| Consociate | $90 | 195% |
| Cypress Benefit Administrators | $90 | 195% |
| Forest County Potawatomi | $90 | 195% |
| Hap | $90 - $149 | 195% |
| Health Smart | $90 | 195% |
| Healthgram | $90 | 195% |
| Healthscope | $90 | 195% |
| Secureone Preferred United Plans | $90 | 195% |
| Sisco Benefits | $90 | 195% |
| The Health Plan | $90 | 195% |
| Trustmark Small Business Benefits | $90 | 195% |
| Unified Group Services | $90 | 195% |
| Varipro | $90 | 195% |
| Webtpa | $90 | 195% |
| Mclaren Health | $98 - $107 | 213% |
| Carelon Behavioral Health | $102 | 221% |
| Employee Benefit Logistic | $102 | 221% |
| Magellan Behavioral Health | $122 | 265% |
| Geha | $128 - $153 | 278% |
| Medical Mutual | $128 | 278% |
| Meritain | $128 | 278% |
| 1199 National Benefit Fund | $139 | 302% |
| Allied National Global Care | $139 | 302% |
| Asrm - Reliance Standard Life Insurance | $139 | 302% |
| Christian Care Ministry | $139 | 302% |
| Dean Health | $139 | 302% |
| Fallon Health | $139 | 302% |
| Family Life Insurance Company | $139 | 302% |
| Ghc Scw | $139 | 302% |
| Group Pension Administrators | $139 | 302% |
| International Benefit Administrators | $139 | 302% |
| Lifetime Benefit Solutions | $139 | 302% |
| Manhattan Life | $139 | 302% |
| Medi Share | $139 | 302% |
| Multiplan | $139 | 302% |
| Mvp | $139 | 302% |
| Pai | $139 | 302% |
| Pan-American Life | $139 | 302% |
| Paramount Hmo | $139 | 302% |
| Phcs | $139 | 302% |
| Trinity Health Share | $139 | 302% |
| Health Partners | $149 | 323% |
| Tufts Health Plan | $149 | 323% |
| Access Health | $150 | 325% |
| Acclaim | $150 | 325% |
| Administrative Concepts | $150 | 325% |
| Allegeant | $150 | 325% |
| Ameriben | $150 | 325% |
| American Family | $150 | 325% |
| American Healthcare Alliance | $150 | 325% |
| American National | $150 | 325% |
| American Republic | $150 | 325% |
| Amerihealth | $150 | 325% |
| Aultcare | $150 | 325% |
| Automated Benefit Services | $150 | 325% |
| Auxiant | $150 | 325% |
| Benefit Administrative Systems,Llc | $150 | 325% |
| Boon Chapman | $150 | 325% |
| Cam Administrative Services | $150 | 325% |
| Christian Brother Services | $150 | 325% |
| Christian Brothers Holy Cross | $150 | 325% |
| Comprehensive Benefits | $150 | 325% |
| Continental Life Insurance | $150 | 325% |
| Custom Benefit Administrators | $150 | 325% |
| Employee Benefit Concepts | $150 | 325% |
| Employee Benefit Management | $150 | 325% |
| Enterprise Group Planning | $150 | 325% |
| Freedom Life Insurance Company | $150 | 325% |
| Group Administrators | $150 | 325% |
| Group Marketing Services | $150 | 325% |
| Guardian | $150 | 325% |
| Health America | $150 | 325% |
| Healthcare Management Admin | $150 | 325% |
| Healthez | $150 | 325% |
| Humana | $150 | 325% |
| Insight | $150 | 325% |
| Intercare | $150 | 325% |
| Jfp Benefit Management | $150 | 325% |
| Jp Farley Corporation | $150 | 325% |
| Key Benefit Administrator | $150 | 325% |
| Liberty Union Life Assurance Co | $150 | 325% |
| Lucent Health | $150 | 325% |
| Luminare Health | $150 | 325% |
| Luminare Health (Detroit) | $150 | 325% |
| Magnacare | $150 | 325% |
| Medben | $150 | 325% |
| Medcost | $150 | 325% |
| Mutual Health Services | $150 | 325% |
| Mutual Of Omaha | $150 | 325% |
| Ncas | $150 | 325% |
| Nippon Life Ins | $150 | 325% |
| Nova | $150 | 325% |
| Painters Union Insurance Fund | $150 | 325% |
| Physicians Mutual | $150 | 325% |
| Plumbers Local 98 Insurance Fund | $150 | 325% |
| Prairie States | $150 | 325% |
| Preferred One | $150 | 325% |
| Primary Physician Care | $150 | 325% |
| Professional Benefit Administrators | $150 | 325% |
| Siho Insurance Services | $150 | 325% |
| The Loomis Company | $150 | 325% |
| Unicare | $150 | 325% |
| Us Health And Life | $150 | 325% |
| Valenz | $150 | 325% |
| Western & Southern Financial Group | $150 | 325% |
| Wps | $150 | 325% |
| Cigna | $151 | 328% |
| Coventry | $154 | 334% |
| First Health | $154 | 334% |
| Prime Health Services | $163 | 354% |
| Three Rivers Provider Network | $184 | 399% |
| Cmh Detroit Wayne Integrated Health Network | $204 | 443% |
| Cmh Lenawee County | $204 | 443% |
| Cmh Livingston County | $204 | 443% |
| Cmh Misc | $204 | 443% |
| Cmh Monroe County | $204 | 443% |
| Cmh Oakland County | $204 | 443% |
| Cmh Washtenaw County | $204 | 443% |