CMS Price Transparency Data
Prosthetic fitting and training
Facility: Trinity Health Oakland Hospital
Billing Code: 97761 (CPT)
Factual Cost Summary (Answer Capsule)
- CPT Billing Code: 97761
- Insurance Median: $123
- Cash Discount Price: $118
- vs. Medicare Baseline: 3.04x Medicare
The contracted insurance negotiated median rate for a Prosthetic fitting and training at Trinity Health Oakland Hospital is $123. 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 3.04x the Medicare baseline. Located in 44405 Woodward Ave, Pontiac, MI.
Cash / Self-Pay
$118
Average discount available for prompt cash payment at this facility.
Insurance Median
$123
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: $123 (304%)
Cash: $118 (292% of Medicare)
Ins. Median: $123 (304% 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 304% of the Medicare baseline (a markup of 204%). 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 - $65 | 54% |
| Medicaid / KanCare | $22 | 54% |
| Aetna | $39 - $113 | 97% |
| Blue Care Network Advantage | $39 | 97% |
| Medicare (plans) | $39 - $40 | 97% |
| Align Senior Care | $40 | 99% |
| Hospice Advantage | $40 | 99% |
| UnitedHealthcare | $41 - $136 | 101% |
| Cca - Zing Health | $42 | 104% |
| Longevity Ipa Of Michigan Llc Health Plan Isnp | $45 | 111% |
| Molina Marketplace | $52 | 129% |
| Priority Health | $54 - $60 | 134% |
| Wc Accident Fund | $55 | 136% |
| Wc Advantage | $55 | 136% |
| Wc Aig | $55 | 136% |
| Wc Allied | $55 | 136% |
| Wc Amerisure | $55 | 136% |
| Wc Amtrust | $55 | 136% |
| Wc Asu Risk Mgt | $55 | 136% |
| Wc Berkley Admin | $55 | 136% |
| Wc Broadspire | $55 | 136% |
| Wc Bunch & Associates | $55 | 136% |
| Wc Ccmsi | $55 | 136% |
| Wc Emc Insurance Company | $55 | 136% |
| Wc Esis | $55 | 136% |
| Wc Fcci | $55 | 136% |
| Wc Federated | $55 | 136% |
| Wc Gallagher Bassett | $55 | 136% |
| Wc Genex Care For Ohio | $55 | 136% |
| Wc Guard Insurance Company | $55 | 136% |
| Wc Hartford | $55 | 136% |
| Wc Liberty Mutual | $55 | 136% |
| Wc Meijers | $55 | 136% |
| Wc Michigan | $55 | 136% |
| Wc Mitchell Frankenmuth | $55 | 136% |
| Wc Pma | $55 | 136% |
| Wc Sedgwick | $55 | 136% |
| Wc Sentry | $55 | 136% |
| Wc Travelers | $55 | 136% |
| Wc Tristar | $55 | 136% |
| Wc Walmart | $55 | 136% |
| Wc Zurich | $55 | 136% |
| Health Cost Solutions | $62 | 153% |
| U Of M Health Plan | $62 | 153% |
| Vitalcore | $62 | 153% |
| Wellpath | $62 | 153% |
| Bcn Domestic | $65 | 161% |
| Blue Benefit Administrators Of Massachusetts | $65 | 161% |
| Blue Care Network | $65 | 161% |
| Blue Distinction Transplant | $65 | 161% |
| Blue Shield - Ca | $65 | 161% |
| Blue Shield - Id (Regence) | $65 | 161% |
| Blue Shield - Ny Highmark Northeastern | $65 | 161% |
| Blue Shield - Ny Highmark Western | $65 | 161% |
| Blue Shield - Pa (Highmark) | $65 | 161% |
| Blue Shield - Wa (Regence) | $65 | 161% |
| Health Choices | $65 - $133 | 161% |
| Kaiser Domestic | $65 | 161% |
| Asr Health Benefits | $78 | 193% |
| Caresource | $78 | 193% |
| Hap | $78 - $132 | 193% |
| Varipro | $78 | 193% |
| Acs Benefit Services | $80 | 198% |
| Allied Benefit Systems | $80 | 198% |
| Claimchoice Adminstrators | $80 | 198% |
| Consociate | $80 | 198% |
| Cypress Benefit Administrators | $80 | 198% |
| Forest County Potawatomi | $80 | 198% |
| Health Smart | $80 | 198% |
| Healthgram | $80 | 198% |
| Healthscope | $80 | 198% |
| Secureone Preferred United Plans | $80 | 198% |
| Sisco Benefits | $80 | 198% |
| The Health Plan | $80 | 198% |
| Trustmark Small Business Benefits | $80 | 198% |
| Unified Group Services | $80 | 198% |
| Webtpa | $80 | 198% |
| Mclaren Health | $87 - $95 | 215% |
| Carelon Behavioral Health | $90 | 223% |
| Employee Benefit Logistic | $90 | 223% |
| Magellan Behavioral Health | $109 | 270% |
| Geha | $113 - $136 | 280% |
| Medical Mutual | $113 | 280% |
| Meritain | $113 | 280% |
| 1199 National Benefit Fund | $123 | 304% |
| Allied National Global Care | $123 | 304% |
| Asrm - Reliance Standard Life Insurance | $123 | 304% |
| Christian Care Ministry | $123 | 304% |
| Dean Health | $123 | 304% |
| Fallon Health | $123 | 304% |
| Family Life Insurance Company | $123 | 304% |
| Ghc Scw | $123 | 304% |
| Group Pension Administrators | $123 | 304% |
| International Benefit Administrators | $123 | 304% |
| Lifetime Benefit Solutions | $123 | 304% |
| Manhattan Life | $123 | 304% |
| Medi Share | $123 | 304% |
| Multiplan | $123 | 304% |
| Mvp | $123 | 304% |
| Pai | $123 | 304% |
| Pan-American Life | $123 | 304% |
| Paramount Hmo | $123 | 304% |
| Phcs | $123 | 304% |
| Trinity Health Share | $123 | 304% |
| Health Partners | $132 | 327% |
| Tufts Health Plan | $132 | 327% |
| Access Health | $133 | 329% |
| Acclaim | $133 | 329% |
| Administrative Concepts | $133 | 329% |
| Allegeant | $133 | 329% |
| Ameriben | $133 | 329% |
| American Family | $133 | 329% |
| American Healthcare Alliance | $133 | 329% |
| American National | $133 | 329% |
| American Republic | $133 | 329% |
| Amerihealth | $133 | 329% |
| Aultcare | $133 | 329% |
| Automated Benefit Services | $133 | 329% |
| Auxiant | $133 | 329% |
| Benefit Administrative Systems,Llc | $133 | 329% |
| Boon Chapman | $133 | 329% |
| Cam Administrative Services | $133 | 329% |
| Christian Brother Services | $133 | 329% |
| Christian Brothers Holy Cross | $133 | 329% |
| Comprehensive Benefits | $133 | 329% |
| Continental Life Insurance | $133 | 329% |
| Custom Benefit Administrators | $133 | 329% |
| Employee Benefit Concepts | $133 | 329% |
| Employee Benefit Management | $133 | 329% |
| Enterprise Group Planning | $133 | 329% |
| Freedom Life Insurance Company | $133 | 329% |
| Group Administrators | $133 | 329% |
| Group Marketing Services | $133 | 329% |
| Guardian | $133 | 329% |
| Health America | $133 | 329% |
| Healthcare Management Admin | $133 | 329% |
| Healthez | $133 | 329% |
| Humana | $133 | 329% |
| Insight | $133 | 329% |
| Intercare | $133 | 329% |
| Jfp Benefit Management | $133 | 329% |
| Jp Farley Corporation | $133 | 329% |
| Key Benefit Administrator | $133 | 329% |
| Liberty Union Life Assurance Co | $133 | 329% |
| Lucent Health | $133 | 329% |
| Luminare Health | $133 | 329% |
| Luminare Health (Detroit) | $133 | 329% |
| Magnacare | $133 | 329% |
| Medben | $133 | 329% |
| Medcost | $133 | 329% |
| Mutual Health Services | $133 | 329% |
| Mutual Of Omaha | $133 | 329% |
| Ncas | $133 | 329% |
| Nippon Life Ins | $133 | 329% |
| Nova | $133 | 329% |
| Painters Union Insurance Fund | $133 | 329% |
| Physicians Mutual | $133 | 329% |
| Plumbers Local 98 Insurance Fund | $133 | 329% |
| Prairie States | $133 | 329% |
| Preferred One | $133 | 329% |
| Primary Physician Care | $133 | 329% |
| Professional Benefit Administrators | $133 | 329% |
| Siho Insurance Services | $133 | 329% |
| The Loomis Company | $133 | 329% |
| Unicare | $133 | 329% |
| Us Health And Life | $133 | 329% |
| Valenz | $133 | 329% |
| Western & Southern Financial Group | $133 | 329% |
| Wps | $133 | 329% |
| Cigna | $134 | 332% |
| Coventry | $136 | 337% |
| First Health | $136 | 337% |
| Prime Health Services | $145 | 359% |
| Three Rivers Provider Network | $163 | 403% |
| 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 Oakland County | $181 | 448% |
| Cmh Washtenaw County | $181 | 448% |