CMS Price Transparency Data
Physical therapy (neuromuscular re-education)
Facility: Trinity Health Oakland Hospital
Billing Code: 97112 (CPT)
Factual Cost Summary (Answer Capsule)
- CPT Billing Code: 97112
- Insurance Median: $119
- Cash Discount Price: $114
- vs. Medicare Baseline: 3.64x Medicare
The contracted insurance negotiated median rate for a Physical therapy (neuromuscular re-education) at Trinity Health Oakland Hospital is $119. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $114. Compared to the federal Medicare reimbursement reference rate of $32.73, this hospital’s rate is 3.64x the Medicare baseline. Located in 44405 Woodward Ave, Pontiac, MI.
Cash / Self-Pay
$114
Average discount available for prompt cash payment at this facility.
Insurance Median
$119
Median negotiated contract rate across all mapped commercial carriers.
Medicare Reference Rate
$32.73
Standard federal government reimbursement rate for this code.
Visual Cost Comparison vs. Medicare
Medicare Reference Baseline: $32.73 (100%)
Cash / Self-Pay: $114 (348%)
Insurance Median: $119 (364%)
Cash: $114 (348% of Medicare)
Ins. Median: $119 (364% of Medicare)
Understanding this gauge: We use the federal Medicare rate of $32.73 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 364% of the Medicare baseline (a markup of 264%). 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 | $18 - $63 | 55% |
| Medicaid / KanCare | $18 | 55% |
| Aetna | $32 - $110 | 98% |
| Blue Care Network Advantage | $32 | 98% |
| Medicare (plans) | $32 - $33 | 98% |
| Align Senior Care | $33 | 101% |
| Hospice Advantage | $33 | 101% |
| Cca - Zing Health | $34 | 104% |
| UnitedHealthcare | $34 - $131 | 104% |
| Longevity Ipa Of Michigan Llc Health Plan Isnp | $37 | 113% |
| Molina Marketplace | $42 | 128% |
| U Of M Health Plan | $49 | 150% |
| Health Cost Solutions | $50 | 153% |
| Vitalcore | $50 | 153% |
| Wellpath | $50 | 153% |
| Wc Accident Fund | $53 | 162% |
| Wc Advantage | $53 | 162% |
| Wc Aig | $53 | 162% |
| Wc Allied | $53 | 162% |
| Wc Amerisure | $53 | 162% |
| Wc Amtrust | $53 | 162% |
| Wc Asu Risk Mgt | $53 | 162% |
| Wc Berkley Admin | $53 | 162% |
| Wc Broadspire | $53 | 162% |
| Wc Bunch & Associates | $53 | 162% |
| Wc Ccmsi | $53 | 162% |
| Wc Emc Insurance Company | $53 | 162% |
| Wc Esis | $53 | 162% |
| Wc Fcci | $53 | 162% |
| Wc Federated | $53 | 162% |
| Wc Gallagher Bassett | $53 | 162% |
| Wc Genex Care For Ohio | $53 | 162% |
| Wc Guard Insurance Company | $53 | 162% |
| Wc Hartford | $53 | 162% |
| Wc Liberty Mutual | $53 | 162% |
| Wc Meijers | $53 | 162% |
| Wc Michigan | $53 | 162% |
| Wc Mitchell Frankenmuth | $53 | 162% |
| Wc Pma | $53 | 162% |
| Wc Sedgwick | $53 | 162% |
| Wc Sentry | $53 | 162% |
| Wc Travelers | $53 | 162% |
| Wc Tristar | $53 | 162% |
| Wc Walmart | $53 | 162% |
| Wc Zurich | $53 | 162% |
| Priority Health | $57 - $63 | 174% |
| Bcn Domestic | $63 | 192% |
| Blue Benefit Administrators Of Massachusetts | $63 | 192% |
| Blue Care Network | $63 | 192% |
| Blue Distinction Transplant | $63 | 192% |
| Blue Shield - Ca | $63 | 192% |
| Blue Shield - Id (Regence) | $63 | 192% |
| Blue Shield - Ny Highmark Northeastern | $63 | 192% |
| Blue Shield - Ny Highmark Western | $63 | 192% |
| Blue Shield - Pa (Highmark) | $63 | 192% |
| Blue Shield - Wa (Regence) | $63 | 192% |
| Health Choices | $63 - $128 | 192% |
| Kaiser Domestic | $63 | 192% |
| Employee Benefit Logistic | $73 | 223% |
| Acs Benefit Services | $77 | 235% |
| Allied Benefit Systems | $77 | 235% |
| Asr Health Benefits | $77 | 235% |
| Caresource | $77 | 235% |
| Claimchoice Adminstrators | $77 | 235% |
| Consociate | $77 | 235% |
| Cypress Benefit Administrators | $77 | 235% |
| Forest County Potawatomi | $77 | 235% |
| Hap | $77 - $127 | 235% |
| Health Smart | $77 | 235% |
| Healthgram | $77 | 235% |
| Healthscope | $77 | 235% |
| Secureone Preferred United Plans | $77 | 235% |
| Sisco Benefits | $77 | 235% |
| The Health Plan | $77 | 235% |
| Trustmark Small Business Benefits | $77 | 235% |
| Unified Group Services | $77 | 235% |
| Varipro | $77 | 235% |
| Webtpa | $77 | 235% |
| Mclaren Health | $84 - $92 | 257% |
| Carelon Behavioral Health | $88 | 269% |
| Magellan Behavioral Health | $105 | 321% |
| Geha | $110 - $131 | 336% |
| Medical Mutual | $110 | 336% |
| Meritain | $110 | 336% |
| 1199 National Benefit Fund | $119 | 364% |
| Allied National Global Care | $119 | 364% |
| Asrm - Reliance Standard Life Insurance | $119 | 364% |
| Christian Care Ministry | $119 | 364% |
| Dean Health | $119 | 364% |
| Fallon Health | $119 | 364% |
| Family Life Insurance Company | $119 | 364% |
| Ghc Scw | $119 | 364% |
| Group Pension Administrators | $119 | 364% |
| International Benefit Administrators | $119 | 364% |
| Lifetime Benefit Solutions | $119 | 364% |
| Manhattan Life | $119 | 364% |
| Medi Share | $119 | 364% |
| Multiplan | $119 | 364% |
| Mvp | $119 | 364% |
| Pai | $119 | 364% |
| Pan-American Life | $119 | 364% |
| Paramount Hmo | $119 | 364% |
| Phcs | $119 | 364% |
| Trinity Health Share | $119 | 364% |
| Health Partners | $127 | 388% |
| Tufts Health Plan | $127 | 388% |
| Access Health | $128 | 391% |
| Acclaim | $128 | 391% |
| Administrative Concepts | $128 | 391% |
| Allegeant | $128 | 391% |
| Ameriben | $128 | 391% |
| American Family | $128 | 391% |
| American Healthcare Alliance | $128 | 391% |
| American National | $128 | 391% |
| American Republic | $128 | 391% |
| Amerihealth | $128 | 391% |
| Aultcare | $128 | 391% |
| Automated Benefit Services | $128 | 391% |
| Auxiant | $128 | 391% |
| Benefit Administrative Systems,Llc | $128 | 391% |
| Boon Chapman | $128 | 391% |
| Cam Administrative Services | $128 | 391% |
| Christian Brother Services | $128 | 391% |
| Christian Brothers Holy Cross | $128 | 391% |
| Comprehensive Benefits | $128 | 391% |
| Continental Life Insurance | $128 | 391% |
| Custom Benefit Administrators | $128 | 391% |
| Employee Benefit Concepts | $128 | 391% |
| Employee Benefit Management | $128 | 391% |
| Enterprise Group Planning | $128 | 391% |
| Freedom Life Insurance Company | $128 | 391% |
| Group Administrators | $128 | 391% |
| Group Marketing Services | $128 | 391% |
| Guardian | $128 | 391% |
| Health America | $128 | 391% |
| Healthcare Management Admin | $128 | 391% |
| Healthez | $128 | 391% |
| Humana | $128 | 391% |
| Insight | $128 | 391% |
| Intercare | $128 | 391% |
| Jfp Benefit Management | $128 | 391% |
| Jp Farley Corporation | $128 | 391% |
| Key Benefit Administrator | $128 | 391% |
| Liberty Union Life Assurance Co | $128 | 391% |
| Lucent Health | $128 | 391% |
| Luminare Health | $128 | 391% |
| Luminare Health (Detroit) | $128 | 391% |
| Magnacare | $128 | 391% |
| Medben | $128 | 391% |
| Medcost | $128 | 391% |
| Mutual Health Services | $128 | 391% |
| Mutual Of Omaha | $128 | 391% |
| Ncas | $128 | 391% |
| Nippon Life Ins | $128 | 391% |
| Nova | $128 | 391% |
| Painters Union Insurance Fund | $128 | 391% |
| Physicians Mutual | $128 | 391% |
| Plumbers Local 98 Insurance Fund | $128 | 391% |
| Prairie States | $128 | 391% |
| Preferred One | $128 | 391% |
| Primary Physician Care | $128 | 391% |
| Professional Benefit Administrators | $128 | 391% |
| Siho Insurance Services | $128 | 391% |
| The Loomis Company | $128 | 391% |
| Unicare | $128 | 391% |
| Us Health And Life | $128 | 391% |
| Valenz | $128 | 391% |
| Western & Southern Financial Group | $128 | 391% |
| Wps | $128 | 391% |
| Cigna | $130 | 397% |
| Coventry | $132 | 403% |
| First Health | $132 | 403% |
| Prime Health Services | $140 | 428% |
| Three Rivers Provider Network | $158 | 483% |
| Cmh Detroit Wayne Integrated Health Network | $175 | 535% |
| Cmh Lenawee County | $175 | 535% |
| Cmh Livingston County | $175 | 535% |
| Cmh Misc | $175 | 535% |
| Cmh Monroe County | $175 | 535% |
| Cmh Oakland County | $175 | 535% |
| Cmh Washtenaw County | $175 | 535% |