CMS Price Transparency Data
Physical therapy (gait training)
Facility: Trinity Health Oakland Hospital
Billing Code: 97116 (CPT)
Factual Cost Summary (Answer Capsule)
- CPT Billing Code: 97116
- Insurance Median: $101
- Cash Discount Price: $34,850
- vs. Medicare Baseline: 3.48x Medicare
The contracted insurance negotiated median rate for a Physical therapy (gait training) at Trinity Health Oakland Hospital is $101. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $34,850. Compared to the federal Medicare reimbursement reference rate of $29.06, this hospital’s rate is 3.48x the Medicare baseline. Located in 44405 Woodward Ave, Pontiac, MI.
Cash / Self-Pay
$34,850
Average discount available for prompt cash payment at this facility.
Insurance Median
$101
Median negotiated contract rate across all mapped commercial carriers.
Medicare Reference Rate
$29.06
Standard federal government reimbursement rate for this code.
Visual Cost Comparison vs. Medicare
Medicare Reference Baseline: $29.06 (100%)
Cash / Self-Pay: $34,850 (119924%)
Insurance Median: $101 (348%)
Cash: $34,850 (119924% of Medicare)
Ins. Median: $101 (348% of Medicare)
Understanding this gauge: We use the federal Medicare rate of $29.06 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 348% of the Medicare baseline (a markup of 248%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.
Out-of-Pocket Cost Estimator
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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 | $16 - $12,537 | 55% |
| Medicaid / KanCare | $16 - $7,171 | 55% |
| Aetna | $28 - $12,537 | 96% |
| Blue Care Network Advantage | $28 - $12,537 | 96% |
| Medicare (plans) | $28 - $12,793 | 96% |
| Align Senior Care | $29 - $12,793 | 100% |
| Hospice Advantage | $29 - $12,793 | 100% |
| UnitedHealthcare | $30 - $13,176 | 103% |
| Cca - Zing Health | $31 - $13,540 | 107% |
| Longevity Ipa Of Michigan Llc Health Plan Isnp | $33 - $14,417 | 114% |
| Molina Marketplace | $38 - $16,630 | 131% |
| U Of M Health Plan | $44 - $88 | 151% |
| Health Cost Solutions | $45 - $19,828 | 155% |
| Vitalcore | $45 - $19,828 | 155% |
| Wc Accident Fund | $45 | 155% |
| Wc Advantage | $45 | 155% |
| Wc Aig | $45 | 155% |
| Wc Allied | $45 | 155% |
| Wc Amerisure | $45 | 155% |
| Wc Amtrust | $45 | 155% |
| Wc Asu Risk Mgt | $45 | 155% |
| Wc Berkley Admin | $45 | 155% |
| Wc Broadspire | $45 | 155% |
| Wc Bunch & Associates | $45 | 155% |
| Wc Ccmsi | $45 | 155% |
| Wc Emc Insurance Company | $45 | 155% |
| Wc Esis | $45 | 155% |
| Wc Fcci | $45 | 155% |
| Wc Federated | $45 | 155% |
| Wc Gallagher Bassett | $45 | 155% |
| Wc Genex Care For Ohio | $45 | 155% |
| Wc Guard Insurance Company | $45 | 155% |
| Wc Hartford | $45 | 155% |
| Wc Liberty Mutual | $45 | 155% |
| Wc Meijers | $45 | 155% |
| Wc Michigan | $45 | 155% |
| Wc Mitchell Frankenmuth | $45 | 155% |
| Wc Pma | $45 | 155% |
| Wc Sedgwick | $45 | 155% |
| Wc Sentry | $45 | 155% |
| Wc Travelers | $45 | 155% |
| Wc Tristar | $45 | 155% |
| Wc Walmart | $45 | 155% |
| Wc Zurich | $45 | 155% |
| Wellpath | $45 - $19,828 | 155% |
| Priority Health | $46 - $102 | 158% |
| Bcn Domestic | $53 | 182% |
| Blue Benefit Administrators Of Massachusetts | $53 | 182% |
| Blue Care Network | $53 | 182% |
| Blue Distinction Transplant | $53 | 182% |
| Blue Shield - Ca | $53 | 182% |
| Blue Shield - Id (Regence) | $53 | 182% |
| Blue Shield - Ny Highmark Northeastern | $53 | 182% |
| Blue Shield - Ny Highmark Western | $53 | 182% |
| Blue Shield - Pa (Highmark) | $53 | 182% |
| Blue Shield - Wa (Regence) | $53 | 182% |
| Health Choices | $53 - $109 | 182% |
| Kaiser Domestic | $53 | 182% |
| Acs Benefit Services | $65 | 224% |
| Allied Benefit Systems | $65 | 224% |
| Claimchoice Adminstrators | $65 | 224% |
| Consociate | $65 | 224% |
| Cypress Benefit Administrators | $65 | 224% |
| Employee Benefit Logistic | $65 - $29,514 | 224% |
| Forest County Potawatomi | $65 | 224% |
| Health Smart | $65 | 224% |
| Healthgram | $65 | 224% |
| Healthscope | $65 | 224% |
| Secureone Preferred United Plans | $65 | 224% |
| Sisco Benefits | $65 | 224% |
| The Health Plan | $65 | 224% |
| Trustmark Small Business Benefits | $65 | 224% |
| Unified Group Services | $65 | 224% |
| Webtpa | $65 | 224% |
| Asr Health Benefits | $66 - $132 | 227% |
| Caresource | $66 - $132 | 227% |
| Hap | $66 - $132 | 227% |
| Varipro | $66 - $132 | 227% |
| Mclaren Health | $71 - $78 | 244% |
| Carelon Behavioral Health | $74 | 255% |
| Magellan Behavioral Health | $89 | 306% |
| Geha | $93 - $111 | 320% |
| Medical Mutual | $93 | 320% |
| Meritain | $93 | 320% |
| 1199 National Benefit Fund | $101 | 348% |
| Allied National Global Care | $101 | 348% |
| Asrm - Reliance Standard Life Insurance | $101 | 348% |
| Christian Care Ministry | $101 | 348% |
| Dean Health | $101 | 348% |
| Fallon Health | $101 | 348% |
| Family Life Insurance Company | $101 | 348% |
| Ghc Scw | $101 | 348% |
| Group Pension Administrators | $101 | 348% |
| International Benefit Administrators | $101 | 348% |
| Lifetime Benefit Solutions | $101 | 348% |
| Manhattan Life | $101 | 348% |
| Medi Share | $101 | 348% |
| Multiplan | $101 | 348% |
| Mvp | $101 | 348% |
| Pai | $101 | 348% |
| Pan-American Life | $101 | 348% |
| Paramount Hmo | $101 | 348% |
| Phcs | $101 | 348% |
| Trinity Health Share | $101 | 348% |
| Health Partners | $108 | 372% |
| Tufts Health Plan | $108 | 372% |
| Access Health | $109 | 375% |
| Acclaim | $109 | 375% |
| Administrative Concepts | $109 | 375% |
| Allegeant | $109 | 375% |
| Ameriben | $109 | 375% |
| American Family | $109 | 375% |
| American Healthcare Alliance | $109 | 375% |
| American National | $109 | 375% |
| American Republic | $109 | 375% |
| Amerihealth | $109 | 375% |
| Aultcare | $109 | 375% |
| Automated Benefit Services | $109 | 375% |
| Auxiant | $109 | 375% |
| Benefit Administrative Systems,Llc | $109 | 375% |
| Boon Chapman | $109 | 375% |
| Cam Administrative Services | $109 | 375% |
| Christian Brother Services | $109 | 375% |
| Christian Brothers Holy Cross | $109 | 375% |
| Comprehensive Benefits | $109 | 375% |
| Continental Life Insurance | $109 | 375% |
| Custom Benefit Administrators | $109 | 375% |
| Employee Benefit Concepts | $109 | 375% |
| Employee Benefit Management | $109 | 375% |
| Enterprise Group Planning | $109 | 375% |
| Freedom Life Insurance Company | $109 | 375% |
| Group Administrators | $109 | 375% |
| Group Marketing Services | $109 | 375% |
| Guardian | $109 | 375% |
| Health America | $109 | 375% |
| Healthcare Management Admin | $109 | 375% |
| Healthez | $109 | 375% |
| Humana | $109 | 375% |
| Insight | $109 | 375% |
| Intercare | $109 | 375% |
| Jfp Benefit Management | $109 | 375% |
| Jp Farley Corporation | $109 | 375% |
| Key Benefit Administrator | $109 | 375% |
| Liberty Union Life Assurance Co | $109 | 375% |
| Lucent Health | $109 | 375% |
| Luminare Health | $109 | 375% |
| Luminare Health (Detroit) | $109 | 375% |
| Magnacare | $109 | 375% |
| Medben | $109 | 375% |
| Medcost | $109 | 375% |
| Mutual Health Services | $109 | 375% |
| Mutual Of Omaha | $109 | 375% |
| Ncas | $109 | 375% |
| Nippon Life Ins | $109 | 375% |
| Nova | $109 | 375% |
| Painters Union Insurance Fund | $109 | 375% |
| Physicians Mutual | $109 | 375% |
| Plumbers Local 98 Insurance Fund | $109 | 375% |
| Prairie States | $109 | 375% |
| Preferred One | $109 | 375% |
| Primary Physician Care | $109 | 375% |
| Professional Benefit Administrators | $109 | 375% |
| Siho Insurance Services | $109 | 375% |
| The Loomis Company | $109 | 375% |
| Unicare | $109 | 375% |
| Us Health And Life | $109 | 375% |
| Valenz | $109 | 375% |
| Western & Southern Financial Group | $109 | 375% |
| Wps | $109 | 375% |
| Cigna | $110 | 379% |
| Coventry | $112 | 385% |
| First Health | $112 | 385% |
| Prime Health Services | $118 | 406% |
| Three Rivers Provider Network | $133 | 458% |
| Cmh Detroit Wayne Integrated Health Network | $148 | 509% |
| Cmh Lenawee County | $148 | 509% |
| Cmh Livingston County | $148 | 509% |
| Cmh Misc | $148 | 509% |
| Cmh Monroe County | $148 | 509% |
| Cmh Oakland County | $148 | 509% |
| Cmh Washtenaw County | $148 | 509% |