CMS Price Transparency Data
Prosthetic fitting and training
Facility: Mercy Health Saint Mary's
Billing Code: 97761 (CPT)
Factual Cost Summary (Answer Capsule)
- CPT Billing Code: 97761
- Insurance Median: $96
- Cash Discount Price: $86
- vs. Medicare Baseline: 2.38x Medicare
The contracted insurance negotiated median rate for a Prosthetic fitting and training at Mercy Health Saint Mary's is $96. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $86. Compared to the federal Medicare reimbursement reference rate of $40.41, this hospital’s rate is 2.38x the Medicare baseline. Located in 200 Jefferson Avenue Se, Grand Rapids, MI.
Cash / Self-Pay
$86
Average discount available for prompt cash payment at this facility.
Insurance Median
$96
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: $86 (213%)
Insurance Median: $96 (238%)
Cash: $86 (213% of Medicare)
Ins. Median: $96 (238% 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 238% of the Medicare baseline (a markup of 138%). 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 | $21 - $64 | 52% |
| Medicaid / KanCare | $21 - $22 | 52% |
| Access Health | $27 | 67% |
| Aetna | $38 - $83 | 94% |
| Blue Care Network Advantage | $38 | 94% |
| Medicare (plans) | $38 | 94% |
| Align Senior Care | $39 | 97% |
| Correctional Recovery | $39 | 97% |
| Hospice Faith | $39 | 97% |
| Hospice Of Holland | $39 | 97% |
| UnitedHealthcare | $40 - $132 | 99% |
| Longevity Ipa Of Michigan Llc Health Plan Isnp | $44 | 109% |
| Oscar | $49 | 121% |
| Molina Marketplace | $50 | 124% |
| Vitalcore | $60 | 148% |
| Wellpath | $60 | 148% |
| U Of M Health Plan | $62 - $100 | 153% |
| Bcn Domestic | $64 | 158% |
| Blue Benefit Administrators Of Massachusetts | $64 | 158% |
| Blue Care Network | $64 | 158% |
| Blue Distinction Transplant | $64 | 158% |
| Blue Shield - Ca | $64 | 158% |
| Blue Shield - Id (Regence) | $64 | 158% |
| Blue Shield - Ny Highmark Northeastern | $64 | 158% |
| Blue Shield - Ny Highmark Western | $64 | 158% |
| Blue Shield - Pa (Highmark) | $64 | 158% |
| Blue Shield - Wa (Regence) | $64 | 158% |
| Health Choices | $64 - $100 | 158% |
| Kaiser Domestic | $64 | 158% |
| Wc Accident Fund | $72 | 178% |
| Wc Advantage | $72 | 178% |
| Wc Aig | $72 | 178% |
| Wc Allied | $72 | 178% |
| Wc Amerisure | $72 | 178% |
| Wc Amtrust | $72 | 178% |
| Wc Asu Risk Mgt | $72 | 178% |
| Wc Berkley Admin | $72 | 178% |
| Wc Broadspire | $72 | 178% |
| Wc Bunch & Associates | $72 | 178% |
| Wc Ccmsi | $72 | 178% |
| Wc Emc Insurance Company | $72 | 178% |
| Wc Esis | $72 | 178% |
| Wc Fcci | $72 | 178% |
| Wc Federated | $72 | 178% |
| Wc Gallagher Bassett | $72 | 178% |
| Wc Genex Care For Ohio | $72 | 178% |
| Wc Guard Insurance Company | $72 | 178% |
| Wc Hartford | $72 | 178% |
| Wc Liberty Mutual | $72 | 178% |
| Wc Meijers | $72 | 178% |
| Wc Michigan | $72 | 178% |
| Wc Mitchell Frankenmuth | $72 | 178% |
| Wc Pma | $72 | 178% |
| Wc Sedgwick | $72 | 178% |
| Wc Sentry | $72 | 178% |
| Wc Travelers | $72 | 178% |
| Wc Tristar | $72 | 178% |
| Wc Walmart | $72 | 178% |
| Wc Zurich | $72 | 178% |
| Priority Health | $73 - $75 | 181% |
| Nomi Health | $74 | 183% |
| Acs Benefit Services | $76 | 188% |
| Allied Benefit Systems | $76 | 188% |
| Claimchoice Adminstrators | $76 | 188% |
| Consociate | $76 | 188% |
| Cypress Benefit Administrators | $76 | 188% |
| Forest County Potawatomi | $76 | 188% |
| Health Smart | $76 | 188% |
| Healthgram | $76 | 188% |
| Healthscope | $76 | 188% |
| Secureone Preferred United Plans | $76 | 188% |
| Sisco Benefits | $76 | 188% |
| The Health Plan | $76 | 188% |
| Trustmark Small Business Benefits | $76 | 188% |
| Unified Group Services | $76 | 188% |
| Webtpa | $76 | 188% |
| Geha | $83 - $100 | 205% |
| Medical Mutual | $83 | 205% |
| Meritain | $83 | 205% |
| Preferred One | $83 | 205% |
| Asr Health Benefits | $84 | 208% |
| Hap | $84 - $102 | 208% |
| Caresource | $86 | 213% |
| Varipro | $86 | 213% |
| 1199 National Benefit Fund | $96 | 238% |
| Allied National Global Care | $96 | 238% |
| Asrm - Reliance Standard Life Insurance | $96 | 238% |
| Christian Care Ministry | $96 | 238% |
| Cigna | $96 | 238% |
| Dean Health | $96 | 238% |
| Fallon Health | $96 | 238% |
| Family Life Insurance Company | $96 | 238% |
| Ghc Scw | $96 | 238% |
| Group Pension Administrators | $96 | 238% |
| International Benefit Administrators | $96 | 238% |
| Lifetime Benefit Solutions | $96 | 238% |
| Manhattan Life | $96 | 238% |
| Medi Share | $96 | 238% |
| Multiplan | $96 | 238% |
| Mvp | $96 | 238% |
| Pai | $96 | 238% |
| Pan-American Life | $96 | 238% |
| Paramount Hmo | $96 | 238% |
| Phcs | $96 | 238% |
| Trinity Health Share | $96 | 238% |
| Acclaim | $100 | 247% |
| Administrative Concepts | $100 | 247% |
| Allegeant | $100 | 247% |
| Ameriben | $100 | 247% |
| American Family | $100 | 247% |
| American Healthcare Alliance | $100 | 247% |
| American Republic | $100 | 247% |
| Amerihealth | $100 | 247% |
| Aultcare | $100 | 247% |
| Automated Benefit Services | $100 | 247% |
| Auxiant | $100 | 247% |
| Benefit Administrative Systems,Llc | $100 | 247% |
| Boon Chapman | $100 | 247% |
| Cam Administrative Services | $100 | 247% |
| Christian Brother Services | $100 | 247% |
| Christian Brothers Holy Cross | $100 | 247% |
| Comprehensive Benefits | $100 | 247% |
| Continental Life Insurance | $100 | 247% |
| Custom Benefit Administrators | $100 | 247% |
| Employee Benefit Concepts | $100 | 247% |
| Employee Benefit Management | $100 | 247% |
| Enterprise Group Planning | $100 | 247% |
| Freedom Life Insurance Company | $100 | 247% |
| Group Administrators | $100 | 247% |
| Group Marketing Services | $100 | 247% |
| Guardian | $100 | 247% |
| Health America | $100 | 247% |
| Healthez | $100 | 247% |
| Humana | $100 - $132 | 247% |
| Insight | $100 | 247% |
| Intercare | $100 | 247% |
| Jfp Benefit Management | $100 | 247% |
| Jp Farley Corporation | $100 | 247% |
| Key Benefit Administrator | $100 | 247% |
| Liberty Union Life Assurance Co | $100 | 247% |
| Lucent Health | $100 | 247% |
| Luminare Health | $100 | 247% |
| Luminare Health (Detroit) | $100 | 247% |
| Medben | $100 | 247% |
| Medcost | $100 | 247% |
| Mutual Health Services | $100 | 247% |
| Mutual Of Omaha | $100 | 247% |
| Ncas | $100 | 247% |
| Nippon Life Ins | $100 | 247% |
| Nova | $100 | 247% |
| Painters Union Insurance Fund | $100 | 247% |
| Physicians Mutual | $100 | 247% |
| Plumbers Local 98 Insurance Fund | $100 | 247% |
| Prairie States | $100 | 247% |
| Primary Physician Care | $100 | 247% |
| Professional Benefit Administrators | $100 | 247% |
| The Loomis Company | $100 | 247% |
| Unicare | $100 | 247% |
| Us Health And Life | $100 | 247% |
| Valenz | $100 | 247% |
| Western & Southern Financial Group | $100 | 247% |
| Wps | $100 | 247% |
| Coventry | $105 | 260% |
| First Health | $105 | 260% |
| Cmh Allegan County | $132 | 327% |
| Cmh Ausable Valley | $132 | 327% |
| Cmh Barry County | $132 | 327% |
| Cmh Berrien County | $132 | 327% |
| Cmh Cass County | $132 | 327% |
| Cmh Clinton-Eaton-Ingham County | $132 | 327% |
| Cmh Kalamazoo | $132 | 327% |
| Cmh Kent County | $132 | 327% |
| Cmh Lenawee County | $132 | 327% |
| Cmh Misc | $132 | 327% |
| Cmh Monroe County | $132 | 327% |
| Cmh Montcalm County | $132 | 327% |
| Cmh Muskegon County | $132 | 327% |
| Cmh Newaygo County | $132 | 327% |
| Cmh North Country | $132 | 327% |
| Cmh Northern Lakes County | $132 | 327% |
| Cmh Ottawa County | $132 | 327% |
| Cmh Van Buren County | $132 | 327% |
| Cmh West Mi County | $132 | 327% |
| Magellan Behavioral Health | $132 | 327% |