CMS Price Transparency Data
Orthotic fitting and training
Facility: Trinity Health Muskegon Hospital
Billing Code: 97760 (CPT)
Factual Cost Summary (Answer Capsule)
- CPT Billing Code: 97760
- Insurance Median: $120
- Cash Discount Price: $104
- vs. Medicare Baseline: 2.60x Medicare
The contracted insurance negotiated median rate for a Orthotic fitting and training at Trinity Health Muskegon Hospital is $120. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $104. Compared to the federal Medicare reimbursement reference rate of $46.09, this hospital’s rate is 2.60x the Medicare baseline. Located in 1500 E Sherman Blvd, Muskegon, MI.
Cash / Self-Pay
$104
Average discount available for prompt cash payment at this facility.
Insurance Median
$120
Median negotiated contract rate across all mapped commercial carriers.
Medicare Reference Rate
$46.09
Standard federal government reimbursement rate for this code.
Visual Cost Comparison vs. Medicare
Medicare Reference Baseline: $46.09 (100%)
Cash / Self-Pay: $104 (226%)
Insurance Median: $120 (260%)
Cash: $104 (226% of Medicare)
Ins. Median: $120 (260% of Medicare)
Understanding this gauge: We use the federal Medicare rate of $46.09 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 260% of the Medicare baseline (a markup of 160%). 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 | $24 - $78 | 52% |
| Medicaid / KanCare | $24 | 52% |
| Access Health | $31 | 67% |
| Aetna | $43 - $108 | 93% |
| Blue Care Network Advantage | $43 | 93% |
| Medicare (plans) | $43 | 93% |
| Align Senior Care | $44 | 95% |
| Correctional Recovery | $44 | 95% |
| Heartland Hospice | $44 | 95% |
| Hospice Harbor Hospice | $44 | 95% |
| UnitedHealthcare | $45 - $141 | 98% |
| Longevity Ipa Of Michigan Llc Health Plan Isnp | $49 | 106% |
| Oscar | $56 | 122% |
| Molina Marketplace | $57 | 124% |
| Vitalcore | $68 | 148% |
| Wellpath | $68 | 148% |
| U Of M Health Plan | $70 - $126 | 152% |
| Bcn Domestic | $78 | 169% |
| Blue Benefit Administrators Of Massachusetts | $78 | 169% |
| Blue Care Network | $78 | 169% |
| Blue Distinction Transplant | $78 | 169% |
| Blue Shield - Ca | $78 | 169% |
| Blue Shield - Id (Regence) | $78 | 169% |
| Blue Shield - Ny Highmark Northeastern | $78 | 169% |
| Blue Shield - Ny Highmark Western | $78 | 169% |
| Blue Shield - Pa (Highmark) | $78 | 169% |
| Blue Shield - Wa (Regence) | $78 | 169% |
| Health Choices | $78 - $126 | 169% |
| Kaiser Domestic | $78 | 169% |
| Priority Health | $80 - $90 | 174% |
| Acs Benefit Services | $83 | 180% |
| Allied Benefit Systems | $83 | 180% |
| Claimchoice Adminstrators | $83 | 180% |
| Consociate | $83 | 180% |
| Cypress Benefit Administrators | $83 | 180% |
| Forest County Potawatomi | $83 | 180% |
| Health Smart | $83 | 180% |
| Healthgram | $83 | 180% |
| Healthscope | $83 | 180% |
| Preferred One | $83 | 180% |
| Secureone Preferred United Plans | $83 | 180% |
| Sisco Benefits | $83 | 180% |
| The Health Plan | $83 | 180% |
| Trustmark Small Business Benefits | $83 | 180% |
| Unified Group Services | $83 | 180% |
| Webtpa | $83 | 180% |
| Asr Health Benefits | $85 | 184% |
| Hap | $85 - $127 | 184% |
| Wc Accident Fund | $85 | 184% |
| Wc Advantage | $85 | 184% |
| Wc Aig | $85 | 184% |
| Wc Allied | $85 | 184% |
| Wc Amerisure | $85 | 184% |
| Wc Amtrust | $85 | 184% |
| Wc Asu Risk Mgt | $85 | 184% |
| Wc Berkley Admin | $85 | 184% |
| Wc Broadspire | $85 | 184% |
| Wc Bunch & Associates | $85 | 184% |
| Wc Ccmsi | $85 | 184% |
| Wc Emc Insurance Company | $85 | 184% |
| Wc Esis | $85 | 184% |
| Wc Fcci | $85 | 184% |
| Wc Federated | $85 | 184% |
| Wc Gallagher Bassett | $85 | 184% |
| Wc Genex Care For Ohio | $85 | 184% |
| Wc Guard Insurance Company | $85 | 184% |
| Wc Hartford | $85 | 184% |
| Wc Liberty Mutual | $85 | 184% |
| Wc Meijers | $85 | 184% |
| Wc Michigan | $85 | 184% |
| Wc Mitchell Frankenmuth | $85 | 184% |
| Wc Pma | $85 | 184% |
| Wc Sedgwick | $85 | 184% |
| Wc Sentry | $85 | 184% |
| Wc Travelers | $85 | 184% |
| Wc Tristar | $85 | 184% |
| Wc Walmart | $85 | 184% |
| Wc Zurich | $85 | 184% |
| Hospice Of Michigan | $88 | 191% |
| Nomi Health | $90 | 195% |
| Varipro | $93 | 202% |
| Caresource | $101 | 219% |
| Cigna | $101 | 219% |
| Geha | $108 - $141 | 234% |
| Meritain | $108 | 234% |
| 1199 National Benefit Fund | $120 | 260% |
| Allied National Global Care | $120 | 260% |
| Asrm - Reliance Standard Life Insurance | $120 | 260% |
| Christian Care Ministry | $120 | 260% |
| Dean Health | $120 | 260% |
| Fallon Health | $120 | 260% |
| Family Life Insurance Company | $120 | 260% |
| Ghc Scw | $120 | 260% |
| Group Pension Administrators | $120 | 260% |
| International Benefit Administrators | $120 | 260% |
| Lifetime Benefit Solutions | $120 | 260% |
| Manhattan Life | $120 | 260% |
| Medi Share | $120 | 260% |
| Multiplan | $120 | 260% |
| Mvp | $120 | 260% |
| Pai | $120 | 260% |
| Pan-American Life | $120 | 260% |
| Paramount Hmo | $120 | 260% |
| Phcs | $120 | 260% |
| Trinity Health Share | $120 | 260% |
| Acclaim | $126 | 273% |
| Administrative Concepts | $126 | 273% |
| Allegeant | $126 | 273% |
| Ameriben | $126 | 273% |
| American Family | $126 | 273% |
| American Healthcare Alliance | $126 | 273% |
| American Republic | $126 | 273% |
| Amerihealth | $126 | 273% |
| Aultcare | $126 | 273% |
| Automated Benefit Services | $126 | 273% |
| Auxiant | $126 | 273% |
| Benefit Administrative Systems,Llc | $126 | 273% |
| Boon Chapman | $126 | 273% |
| Cam Administrative Services | $126 | 273% |
| Christian Brother Services | $126 | 273% |
| Christian Brothers Holy Cross | $126 | 273% |
| Comprehensive Benefits | $126 | 273% |
| Continental Life Insurance | $126 | 273% |
| Custom Benefit Administrators | $126 | 273% |
| Employee Benefit Concepts | $126 | 273% |
| Employee Benefit Management | $126 | 273% |
| Enterprise Group Planning | $126 | 273% |
| Freedom Life Insurance Company | $126 | 273% |
| Group Administrators | $126 | 273% |
| Group Marketing Services | $126 | 273% |
| Guardian | $126 | 273% |
| Health America | $126 | 273% |
| Healthez | $126 | 273% |
| Humana | $126 | 273% |
| Insight | $126 | 273% |
| Intercare | $126 | 273% |
| Jfp Benefit Management | $126 | 273% |
| Jp Farley Corporation | $126 | 273% |
| Key Benefit Administrator | $126 | 273% |
| Liberty Union Life Assurance Co | $126 | 273% |
| Lucent Health | $126 | 273% |
| Luminare Health | $126 | 273% |
| Luminare Health (Detroit) | $126 | 273% |
| Medben | $126 | 273% |
| Medcost | $126 | 273% |
| Medical Mutual | $126 | 273% |
| Mutual Health Services | $126 | 273% |
| Mutual Of Omaha | $126 | 273% |
| Ncas | $126 | 273% |
| Nippon Life Ins | $126 | 273% |
| Nova | $126 | 273% |
| Painters Union Insurance Fund | $126 | 273% |
| Physicians Mutual | $126 | 273% |
| Plumbers Local 98 Insurance Fund | $126 | 273% |
| Prairie States | $126 | 273% |
| Primary Physician Care | $126 | 273% |
| Professional Benefit Administrators | $126 | 273% |
| The Loomis Company | $126 | 273% |
| Unicare | $126 | 273% |
| Us Health And Life | $126 | 273% |
| Valenz | $126 | 273% |
| Western & Southern Financial Group | $126 | 273% |
| Wps | $126 | 273% |
| First Health | $131 | 284% |
| Barinet | $160 | 347% |
| Cmh Allegan County | $160 | 347% |
| Cmh Barry County | $160 | 347% |
| Cmh Berrien County | $160 | 347% |
| Cmh Cass County | $160 | 347% |
| Cmh Kalamazoo | $160 | 347% |
| Cmh Kent County | $160 | 347% |
| Cmh Misc | $160 | 347% |
| Cmh Muskegon County | $160 | 347% |
| Cmh North Country | $160 | 347% |
| Cmh Northern Lakes County | $160 | 347% |
| Cmh Ottawa County | $160 | 347% |
| Cmh Van Buren County | $160 | 347% |
| Cmh West Mi County | $160 | 347% |