CMS Price Transparency Data
Physical therapy (manual therapy)
Facility: Trinity Health Oakland Hospital
Billing Code: 97140 (CPT)
Factual Cost Summary (Answer Capsule)
- CPT Billing Code: 97140
- Insurance Median: $154
- Cash Discount Price: $148
- vs. Medicare Baseline: 5.56x Medicare
The contracted insurance negotiated median rate for a Physical therapy (manual therapy) at Trinity Health Oakland Hospital is $154. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $148. Compared to the federal Medicare reimbursement reference rate of $27.72, this hospital’s rate is 5.56x the Medicare baseline. Located in 44405 Woodward Ave, Pontiac, MI.
Cash / Self-Pay
$148
Average discount available for prompt cash payment at this facility.
Insurance Median
$154
Median negotiated contract rate across all mapped commercial carriers.
Medicare Reference Rate
$27.72
Standard federal government reimbursement rate for this code.
Visual Cost Comparison vs. Medicare
Medicare Reference Baseline: $27.72 (100%)
Cash / Self-Pay: $148 (534%)
Insurance Median: $154 (556%)
Cash: $148 (534% of Medicare)
Ins. Median: $154 (556% of Medicare)
Understanding this gauge: We use the federal Medicare rate of $27.72 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 556% of the Medicare baseline (a markup of 456%). 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.
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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 | $15 - $81 | 54% |
| Medicaid / KanCare | $15 | 54% |
| Aetna | $27 - $142 | 97% |
| Blue Care Network Advantage | $27 | 97% |
| Medicare (plans) | $27 - $28 | 97% |
| Align Senior Care | $28 | 101% |
| Hospice Advantage | $28 | 101% |
| UnitedHealthcare | $28 - $170 | 101% |
| Cca - Zing Health | $29 | 105% |
| Longevity Ipa Of Michigan Llc Health Plan Isnp | $31 | 112% |
| Molina Marketplace | $36 | 130% |
| U Of M Health Plan | $42 | 152% |
| Health Cost Solutions | $43 | 155% |
| Vitalcore | $43 | 155% |
| Wellpath | $43 | 155% |
| Priority Health | $47 - $53 | 170% |
| Employee Benefit Logistic | $62 | 224% |
| Asr Health Benefits | $69 | 249% |
| Caresource | $69 | 249% |
| Hap | $69 - $165 | 249% |
| Varipro | $69 | 249% |
| Wc Accident Fund | $69 | 249% |
| Wc Advantage | $69 | 249% |
| Wc Aig | $69 | 249% |
| Wc Allied | $69 | 249% |
| Wc Amerisure | $69 | 249% |
| Wc Amtrust | $69 | 249% |
| Wc Asu Risk Mgt | $69 | 249% |
| Wc Berkley Admin | $69 | 249% |
| Wc Broadspire | $69 | 249% |
| Wc Bunch & Associates | $69 | 249% |
| Wc Ccmsi | $69 | 249% |
| Wc Emc Insurance Company | $69 | 249% |
| Wc Esis | $69 | 249% |
| Wc Fcci | $69 | 249% |
| Wc Federated | $69 | 249% |
| Wc Gallagher Bassett | $69 | 249% |
| Wc Genex Care For Ohio | $69 | 249% |
| Wc Guard Insurance Company | $69 | 249% |
| Wc Hartford | $69 | 249% |
| Wc Liberty Mutual | $69 | 249% |
| Wc Meijers | $69 | 249% |
| Wc Michigan | $69 | 249% |
| Wc Mitchell Frankenmuth | $69 | 249% |
| Wc Pma | $69 | 249% |
| Wc Sedgwick | $69 | 249% |
| Wc Sentry | $69 | 249% |
| Wc Travelers | $69 | 249% |
| Wc Tristar | $69 | 249% |
| Wc Walmart | $69 | 249% |
| Wc Zurich | $69 | 249% |
| Bcn Domestic | $81 | 292% |
| Blue Benefit Administrators Of Massachusetts | $81 | 292% |
| Blue Care Network | $81 | 292% |
| Blue Distinction Transplant | $81 | 292% |
| Blue Shield - Ca | $81 | 292% |
| Blue Shield - Id (Regence) | $81 | 292% |
| Blue Shield - Ny Highmark Northeastern | $81 | 292% |
| Blue Shield - Ny Highmark Western | $81 | 292% |
| Blue Shield - Pa (Highmark) | $81 | 292% |
| Blue Shield - Wa (Regence) | $81 | 292% |
| Health Choices | $81 - $167 | 292% |
| Kaiser Domestic | $81 | 292% |
| Acs Benefit Services | $100 | 361% |
| Allied Benefit Systems | $100 | 361% |
| Claimchoice Adminstrators | $100 | 361% |
| Consociate | $100 | 361% |
| Cypress Benefit Administrators | $100 | 361% |
| Forest County Potawatomi | $100 | 361% |
| Health Smart | $100 | 361% |
| Healthgram | $100 | 361% |
| Healthscope | $100 | 361% |
| Secureone Preferred United Plans | $100 | 361% |
| Sisco Benefits | $100 | 361% |
| The Health Plan | $100 | 361% |
| Trustmark Small Business Benefits | $100 | 361% |
| Unified Group Services | $100 | 361% |
| Webtpa | $100 | 361% |
| Mclaren Health | $109 - $119 | 393% |
| Carelon Behavioral Health | $114 | 411% |
| Magellan Behavioral Health | $136 | 491% |
| Geha | $142 - $170 | 512% |
| Medical Mutual | $142 | 512% |
| Meritain | $142 | 512% |
| 1199 National Benefit Fund | $154 | 556% |
| Allied National Global Care | $154 | 556% |
| Asrm - Reliance Standard Life Insurance | $154 | 556% |
| Christian Care Ministry | $154 | 556% |
| Dean Health | $154 | 556% |
| Fallon Health | $154 | 556% |
| Family Life Insurance Company | $154 | 556% |
| Ghc Scw | $154 | 556% |
| Group Pension Administrators | $154 | 556% |
| International Benefit Administrators | $154 | 556% |
| Lifetime Benefit Solutions | $154 | 556% |
| Manhattan Life | $154 | 556% |
| Medi Share | $154 | 556% |
| Multiplan | $154 | 556% |
| Mvp | $154 | 556% |
| Pai | $154 | 556% |
| Pan-American Life | $154 | 556% |
| Paramount Hmo | $154 | 556% |
| Phcs | $154 | 556% |
| Trinity Health Share | $154 | 556% |
| Health Partners | $165 | 595% |
| Tufts Health Plan | $165 | 595% |
| Access Health | $167 | 602% |
| Acclaim | $167 | 602% |
| Administrative Concepts | $167 | 602% |
| Allegeant | $167 | 602% |
| Ameriben | $167 | 602% |
| American Family | $167 | 602% |
| American Healthcare Alliance | $167 | 602% |
| American National | $167 | 602% |
| American Republic | $167 | 602% |
| Amerihealth | $167 | 602% |
| Aultcare | $167 | 602% |
| Automated Benefit Services | $167 | 602% |
| Auxiant | $167 | 602% |
| Benefit Administrative Systems,Llc | $167 | 602% |
| Boon Chapman | $167 | 602% |
| Cam Administrative Services | $167 | 602% |
| Christian Brother Services | $167 | 602% |
| Christian Brothers Holy Cross | $167 | 602% |
| Comprehensive Benefits | $167 | 602% |
| Continental Life Insurance | $167 | 602% |
| Custom Benefit Administrators | $167 | 602% |
| Employee Benefit Concepts | $167 | 602% |
| Employee Benefit Management | $167 | 602% |
| Enterprise Group Planning | $167 | 602% |
| Freedom Life Insurance Company | $167 | 602% |
| Group Administrators | $167 | 602% |
| Group Marketing Services | $167 | 602% |
| Guardian | $167 | 602% |
| Health America | $167 | 602% |
| Healthcare Management Admin | $167 | 602% |
| Healthez | $167 | 602% |
| Humana | $167 | 602% |
| Insight | $167 | 602% |
| Intercare | $167 | 602% |
| Jfp Benefit Management | $167 | 602% |
| Jp Farley Corporation | $167 | 602% |
| Key Benefit Administrator | $167 | 602% |
| Liberty Union Life Assurance Co | $167 | 602% |
| Lucent Health | $167 | 602% |
| Luminare Health | $167 | 602% |
| Luminare Health (Detroit) | $167 | 602% |
| Magnacare | $167 | 602% |
| Medben | $167 | 602% |
| Medcost | $167 | 602% |
| Mutual Health Services | $167 | 602% |
| Mutual Of Omaha | $167 | 602% |
| Ncas | $167 | 602% |
| Nippon Life Ins | $167 | 602% |
| Nova | $167 | 602% |
| Painters Union Insurance Fund | $167 | 602% |
| Physicians Mutual | $167 | 602% |
| Plumbers Local 98 Insurance Fund | $167 | 602% |
| Prairie States | $167 | 602% |
| Preferred One | $167 | 602% |
| Primary Physician Care | $167 | 602% |
| Professional Benefit Administrators | $167 | 602% |
| Siho Insurance Services | $167 | 602% |
| The Loomis Company | $167 | 602% |
| Unicare | $167 | 602% |
| Us Health And Life | $167 | 602% |
| Valenz | $167 | 602% |
| Western & Southern Financial Group | $167 | 602% |
| Wps | $167 | 602% |
| Cigna | $168 | 606% |
| Coventry | $171 | 617% |
| First Health | $171 | 617% |
| Prime Health Services | $182 | 657% |
| Three Rivers Provider Network | $204 | 736% |
| Cmh Detroit Wayne Integrated Health Network | $227 | 819% |
| Cmh Lenawee County | $227 | 819% |
| Cmh Livingston County | $227 | 819% |
| Cmh Misc | $227 | 819% |
| Cmh Monroe County | $227 | 819% |
| Cmh Oakland County | $227 | 819% |
| Cmh Washtenaw County | $227 | 819% |