CMS Price Transparency Data
Prosthetic fitting and training
Facility: Trinity Health Muskegon Hospital
Billing Code: 97761 (CPT)
Factual Cost Summary (Answer Capsule)
- CPT Billing Code: 97761
- Insurance Median: $99
- Cash Discount Price: $86
- vs. Medicare Baseline: 2.45x Medicare
The contracted insurance negotiated median rate for a Prosthetic fitting and training at Trinity Health Muskegon Hospital is $99. 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 2.45x the Medicare baseline. Located in 1500 E Sherman Blvd, Muskegon, MI.
Cash / Self-Pay
$86
Average discount available for prompt cash payment at this facility.
Insurance Median
$99
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: $99 (245%)
Cash: $86 (213% of Medicare)
Ins. Median: $99 (245% 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 245% of the Medicare baseline (a markup of 145%). 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 - $90 | 94% |
| Blue Care Network Advantage | $38 | 94% |
| Medicare (plans) | $38 | 94% |
| Align Senior Care | $39 | 97% |
| Correctional Recovery | $39 | 97% |
| Heartland Hospice | $39 | 97% |
| Hospice Harbor Hospice | $39 | 97% |
| UnitedHealthcare | $40 - $116 | 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 - $104 | 153% |
| Priority Health | $63 - $70 | 156% |
| 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 - $104 | 158% |
| Kaiser Domestic | $64 | 158% |
| Acs Benefit Services | $69 | 171% |
| Allied Benefit Systems | $69 | 171% |
| Claimchoice Adminstrators | $69 | 171% |
| Consociate | $69 | 171% |
| Cypress Benefit Administrators | $69 | 171% |
| Forest County Potawatomi | $69 | 171% |
| Health Smart | $69 | 171% |
| Healthgram | $69 | 171% |
| Healthscope | $69 | 171% |
| Preferred One | $69 | 171% |
| Secureone Preferred United Plans | $69 | 171% |
| Sisco Benefits | $69 | 171% |
| The Health Plan | $69 | 171% |
| Trustmark Small Business Benefits | $69 | 171% |
| Unified Group Services | $69 | 171% |
| Webtpa | $69 | 171% |
| Asr Health Benefits | $70 | 173% |
| Hap | $70 - $105 | 173% |
| Wc Accident Fund | $70 | 173% |
| Wc Advantage | $70 | 173% |
| Wc Aig | $70 | 173% |
| Wc Allied | $70 | 173% |
| Wc Amerisure | $70 | 173% |
| Wc Amtrust | $70 | 173% |
| Wc Asu Risk Mgt | $70 | 173% |
| Wc Berkley Admin | $70 | 173% |
| Wc Broadspire | $70 | 173% |
| Wc Bunch & Associates | $70 | 173% |
| Wc Ccmsi | $70 | 173% |
| Wc Emc Insurance Company | $70 | 173% |
| Wc Esis | $70 | 173% |
| Wc Fcci | $70 | 173% |
| Wc Federated | $70 | 173% |
| Wc Gallagher Bassett | $70 | 173% |
| Wc Genex Care For Ohio | $70 | 173% |
| Wc Guard Insurance Company | $70 | 173% |
| Wc Hartford | $70 | 173% |
| Wc Liberty Mutual | $70 | 173% |
| Wc Meijers | $70 | 173% |
| Wc Michigan | $70 | 173% |
| Wc Mitchell Frankenmuth | $70 | 173% |
| Wc Pma | $70 | 173% |
| Wc Sedgwick | $70 | 173% |
| Wc Sentry | $70 | 173% |
| Wc Travelers | $70 | 173% |
| Wc Tristar | $70 | 173% |
| Wc Walmart | $70 | 173% |
| Wc Zurich | $70 | 173% |
| Hospice Of Michigan | $73 | 181% |
| Nomi Health | $74 | 183% |
| Varipro | $76 | 188% |
| Caresource | $83 | 205% |
| Cigna | $83 | 205% |
| Geha | $90 - $116 | 223% |
| Meritain | $90 | 223% |
| 1199 National Benefit Fund | $99 | 245% |
| Allied National Global Care | $99 | 245% |
| Asrm - Reliance Standard Life Insurance | $99 | 245% |
| Christian Care Ministry | $99 | 245% |
| Dean Health | $99 | 245% |
| Fallon Health | $99 | 245% |
| Family Life Insurance Company | $99 | 245% |
| Ghc Scw | $99 | 245% |
| Group Pension Administrators | $99 | 245% |
| International Benefit Administrators | $99 | 245% |
| Lifetime Benefit Solutions | $99 | 245% |
| Manhattan Life | $99 | 245% |
| Medi Share | $99 | 245% |
| Multiplan | $99 | 245% |
| Mvp | $99 | 245% |
| Pai | $99 | 245% |
| Pan-American Life | $99 | 245% |
| Paramount Hmo | $99 | 245% |
| Phcs | $99 | 245% |
| Trinity Health Share | $99 | 245% |
| Acclaim | $104 | 257% |
| Administrative Concepts | $104 | 257% |
| Allegeant | $104 | 257% |
| Ameriben | $104 | 257% |
| American Family | $104 | 257% |
| American Healthcare Alliance | $104 | 257% |
| American Republic | $104 | 257% |
| Amerihealth | $104 | 257% |
| Aultcare | $104 | 257% |
| Automated Benefit Services | $104 | 257% |
| Auxiant | $104 | 257% |
| Benefit Administrative Systems,Llc | $104 | 257% |
| Boon Chapman | $104 | 257% |
| Cam Administrative Services | $104 | 257% |
| Christian Brother Services | $104 | 257% |
| Christian Brothers Holy Cross | $104 | 257% |
| Comprehensive Benefits | $104 | 257% |
| Continental Life Insurance | $104 | 257% |
| Custom Benefit Administrators | $104 | 257% |
| Employee Benefit Concepts | $104 | 257% |
| Employee Benefit Management | $104 | 257% |
| Enterprise Group Planning | $104 | 257% |
| Freedom Life Insurance Company | $104 | 257% |
| Group Administrators | $104 | 257% |
| Group Marketing Services | $104 | 257% |
| Guardian | $104 | 257% |
| Health America | $104 | 257% |
| Healthez | $104 | 257% |
| Humana | $104 | 257% |
| Insight | $104 | 257% |
| Intercare | $104 | 257% |
| Jfp Benefit Management | $104 | 257% |
| Jp Farley Corporation | $104 | 257% |
| Key Benefit Administrator | $104 | 257% |
| Liberty Union Life Assurance Co | $104 | 257% |
| Lucent Health | $104 | 257% |
| Luminare Health | $104 | 257% |
| Luminare Health (Detroit) | $104 | 257% |
| Medben | $104 | 257% |
| Medcost | $104 | 257% |
| Medical Mutual | $104 | 257% |
| Mutual Health Services | $104 | 257% |
| Mutual Of Omaha | $104 | 257% |
| Ncas | $104 | 257% |
| Nippon Life Ins | $104 | 257% |
| Nova | $104 | 257% |
| Painters Union Insurance Fund | $104 | 257% |
| Physicians Mutual | $104 | 257% |
| Plumbers Local 98 Insurance Fund | $104 | 257% |
| Prairie States | $104 | 257% |
| Primary Physician Care | $104 | 257% |
| Professional Benefit Administrators | $104 | 257% |
| The Loomis Company | $104 | 257% |
| Unicare | $104 | 257% |
| Us Health And Life | $104 | 257% |
| Valenz | $104 | 257% |
| Western & Southern Financial Group | $104 | 257% |
| Wps | $104 | 257% |
| First Health | $108 | 267% |
| Barinet | $132 | 327% |
| Cmh Allegan County | $132 | 327% |
| Cmh Barry County | $132 | 327% |
| Cmh Berrien County | $132 | 327% |
| Cmh Cass County | $132 | 327% |
| Cmh Kalamazoo | $132 | 327% |
| Cmh Kent County | $132 | 327% |
| Cmh Misc | $132 | 327% |
| Cmh Muskegon 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% |