CMS Price Transparency Data
Physical therapy (gait training)
Facility: Trinity Health Livingston Hospital
Billing Code: 97116 (CPT)
Factual Cost Summary (Answer Capsule)
- CPT Billing Code: 97116
- Insurance Median: $108
- Cash Discount Price: $96
- vs. Medicare Baseline: 3.72x Medicare
The contracted insurance negotiated median rate for a Physical therapy (gait training) at Trinity Health Livingston Hospital is $108. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $96. Compared to the federal Medicare reimbursement reference rate of $29.06, this hospital’s rate is 3.72x the Medicare baseline. Located in 620 Byron Rd, Howell, MI.
Cash / Self-Pay
$96
Average discount available for prompt cash payment at this facility.
Insurance Median
$108
Median negotiated contract rate across all mapped commercial carriers.
Medicare Reference Rate
$29.06
Standard federal government reimbursement rate for this code.
Visual Cost Comparison vs. Medicare
Medicare Reference Baseline: $29.06 (100%)
Cash / Self-Pay: $96 (330%)
Insurance Median: $108 (372%)
Cash: $96 (330% of Medicare)
Ins. Median: $108 (372% of Medicare)
Understanding this gauge: We use the federal Medicare rate of $29.06 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 372% of the Medicare baseline (a markup of 272%). 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 | $15 - $53 | 52% |
| Medicaid / KanCare | $15 - $16 | 52% |
| Aetna | $27 - $99 | 93% |
| Blue Care Network Advantage | $27 | 93% |
| Hospice Of Lansing | $27 | 93% |
| Huron Valley Pace | $27 | 93% |
| Medicare (plans) | $27 - $28 | 93% |
| Align Senior Care | $28 | 96% |
| Angela Hospice | $29 | 100% |
| UnitedHealthcare | $29 - $133 | 100% |
| Cca - Zing Health | $30 | 103% |
| Longevity Ipa Of Michigan Llc Health Plan Isnp | $32 | 110% |
| Wc Accident Fund | $32 | 110% |
| Wc Advantage | $32 | 110% |
| Wc Aig | $32 | 110% |
| Wc Allied | $32 | 110% |
| Wc Amerisure | $32 | 110% |
| Wc Amtrust | $32 | 110% |
| Wc Asu Risk Mgt | $32 | 110% |
| Wc Berkley Admin | $32 | 110% |
| Wc Broadspire | $32 | 110% |
| Wc Bunch & Associates | $32 | 110% |
| Wc Ccmsi | $32 | 110% |
| Wc Emc Insurance Company | $32 | 110% |
| Wc Esis | $32 | 110% |
| Wc Fcci | $32 | 110% |
| Wc Federated | $32 | 110% |
| Wc Gallagher Bassett | $32 | 110% |
| Wc Genex Care For Ohio | $32 | 110% |
| Wc Guard Insurance Company | $32 | 110% |
| Wc Hartford | $32 | 110% |
| Wc Liberty Mutual | $32 | 110% |
| Wc Meijers | $32 | 110% |
| Wc Michigan | $32 | 110% |
| Wc Mitchell Frankenmuth | $32 | 110% |
| Wc Pma | $32 | 110% |
| Wc Sedgwick | $32 | 110% |
| Wc Sentry | $32 | 110% |
| Wc Travelers | $32 | 110% |
| Wc Tristar | $32 | 110% |
| Wc Walmart | $32 | 110% |
| Wc Zurich | $32 | 110% |
| Molina Marketplace | $36 | 124% |
| Health Cost Solutions | $43 | 148% |
| Vitalcore | $43 | 148% |
| Wellpath | $43 | 148% |
| U Of M Health Plan | $44 | 151% |
| Priority Health | $51 - $57 | 175% |
| Bcn Domestic | $53 | 182% |
| Blue Benefit Administrators Of Massachusetts | $53 | 182% |
| Blue Care Network | $53 | 182% |
| Blue Distinction Transplant | $53 | 182% |
| Blue Shield - Ca | $53 | 182% |
| Blue Shield - Id (Regence) | $53 | 182% |
| Blue Shield - Ny Highmark Northeastern | $53 | 182% |
| Blue Shield - Ny Highmark Western | $53 | 182% |
| Blue Shield - Pa (Highmark) | $53 | 182% |
| Blue Shield - Wa (Regence) | $53 | 182% |
| Health Choices | $53 - $121 | 182% |
| Kaiser Domestic | $53 | 182% |
| Employee Benefit Logistic | $63 | 217% |
| Acs Benefit Services | $70 | 241% |
| Allied Benefit Systems | $70 | 241% |
| Claimchoice Adminstrators | $70 | 241% |
| Consociate | $70 | 241% |
| Cypress Benefit Administrators | $70 | 241% |
| Forest County Potawatomi | $70 | 241% |
| Health Smart | $70 | 241% |
| Healthgram | $70 | 241% |
| Healthscope | $70 | 241% |
| Secureone Preferred United Plans | $70 | 241% |
| Sisco Benefits | $70 | 241% |
| The Health Plan | $70 | 241% |
| Trustmark Small Business Benefits | $70 | 241% |
| Unified Group Services | $70 | 241% |
| Webtpa | $70 | 241% |
| Asr Health Benefits | $72 | 248% |
| Caresource | $72 | 248% |
| Hap | $72 - $115 | 248% |
| Varipro | $72 | 248% |
| Geha | $99 - $108 | 341% |
| Meritain | $99 | 341% |
| Hospice Advantage | $104 | 358% |
| 1199 National Benefit Fund | $114 | 392% |
| Allied National Global Care | $114 | 392% |
| Asrm - Reliance Standard Life Insurance | $114 | 392% |
| Christian Care Ministry | $114 | 392% |
| Dean Health | $114 | 392% |
| Fallon Health | $114 | 392% |
| Family Life Insurance Company | $114 | 392% |
| Ghc Scw | $114 | 392% |
| Group Pension Administrators | $114 | 392% |
| International Benefit Administrators | $114 | 392% |
| Lifetime Benefit Solutions | $114 | 392% |
| Manhattan Life | $114 | 392% |
| Medi Share | $114 | 392% |
| Multiplan | $114 | 392% |
| Mvp | $114 | 392% |
| Pai | $114 | 392% |
| Pan-American Life | $114 | 392% |
| Paramount Hmo | $114 | 392% |
| Phcs | $114 | 392% |
| Trinity Health Share | $114 | 392% |
| Cigna | $115 | 396% |
| Health Partners | $115 | 396% |
| Tufts Health Plan | $115 | 396% |
| Prime Health Services | $118 | 406% |
| Access Health | $121 | 416% |
| Acclaim | $121 | 416% |
| Administrative Concepts | $121 | 416% |
| Allegeant | $121 | 416% |
| Ameriben | $121 | 416% |
| American Family | $121 | 416% |
| American Healthcare Alliance | $121 | 416% |
| American National | $121 | 416% |
| American Republic | $121 | 416% |
| Amerihealth | $121 | 416% |
| Aultcare | $121 | 416% |
| Automated Benefit Services | $121 | 416% |
| Auxiant | $121 | 416% |
| Benefit Administrative Systems,Llc | $121 | 416% |
| Boon Chapman | $121 | 416% |
| Cam Administrative Services | $121 | 416% |
| Christian Brother Services | $121 | 416% |
| Christian Brothers Holy Cross | $121 | 416% |
| Comprehensive Benefits | $121 | 416% |
| Continental Life Insurance | $121 | 416% |
| Coventry | $121 | 416% |
| Custom Benefit Administrators | $121 | 416% |
| Employee Benefit Concepts | $121 | 416% |
| Employee Benefit Management | $121 | 416% |
| Enterprise Group Planning | $121 | 416% |
| Freedom Life Insurance Company | $121 | 416% |
| Group Administrators | $121 | 416% |
| Group Marketing Services | $121 | 416% |
| Guardian | $121 | 416% |
| Health America | $121 | 416% |
| Healthcare Management Admin | $121 | 416% |
| Healthez | $121 | 416% |
| Humana | $121 | 416% |
| Insight | $121 | 416% |
| Intercare | $121 | 416% |
| Jfp Benefit Management | $121 | 416% |
| Jp Farley Corporation | $121 | 416% |
| Key Benefit Administrator | $121 | 416% |
| Liberty Union Life Assurance Co | $121 | 416% |
| Lucent Health | $121 | 416% |
| Luminare Health | $121 | 416% |
| Luminare Health (Detroit) | $121 | 416% |
| Magnacare | $121 | 416% |
| Medben | $121 | 416% |
| Medcost | $121 | 416% |
| Medical Mutual | $121 | 416% |
| Mutual Health Services | $121 | 416% |
| Mutual Of Omaha | $121 | 416% |
| Ncas | $121 | 416% |
| Nippon Life Ins | $121 | 416% |
| Nova | $121 | 416% |
| Painters Union Insurance Fund | $121 | 416% |
| Physicians Mutual | $121 | 416% |
| Plumbers Local 98 Insurance Fund | $121 | 416% |
| Prairie States | $121 | 416% |
| Preferred One | $121 | 416% |
| Primary Physician Care | $121 | 416% |
| Professional Benefit Administrators | $121 | 416% |
| Siho Insurance Services | $121 | 416% |
| The Loomis Company | $121 | 416% |
| Unicare | $121 | 416% |
| Us Health And Life | $121 | 416% |
| Valenz | $121 | 416% |
| Western & Southern Financial Group | $121 | 416% |
| Wps | $121 | 416% |
| First Health | $124 | 427% |
| Correctional Healthcare Consultants | $131 | 451% |
| Three Rivers Provider Network | $133 | 458% |
| Cmh Washtenaw County | $148 | 509% |