CMS Price Transparency Data

Prosthetic fitting and training

Facility: Covenant Medical Center

Billing Code: 97761 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97761
Insurance Median: $38
Cash Discount Price: $97
vs. Medicare Baseline: 0.94x Medicare

The contracted insurance negotiated median rate for a Prosthetic fitting and training at Covenant Medical Center is $38. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $97. Compared to the federal Medicare reimbursement reference rate of $40.41, this hospital’s rate is 0.94x the Medicare baseline. Located in 1447 N Harrison, Saginaw, MI.

Cash / Self-Pay

$97

Average discount available for prompt cash payment at this facility.

Insurance Median

$38

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: $97 (240%)

Insurance Median: $38 (94%)

Cash: $97 (240% of Medicare)

Ins. Median: $38 (94% 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.

Out-of-Pocket Cost Estimator

Estimate whether it is more economical to use your insurance or pay the upfront self-pay cash rate.

Billing Status

Remaining Deductible ($)

Your Coinsurance 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	$20 - $80	49%
Health Advantage Mclaren Employee	$20 - $76	49%
Healthy Michigan Mclaren	$20 - $38	49%
Healthy Michigan Meridian	$20 - $38	49%
Healthy Michigan Molina	$20 - $38	49%
Healthy Michigan Priority Health	$20 - $38	49%
Priority Health E	$21 - $63	52%
Physicians Health Plan	$25 - $76	62%
Priority Health	$25 - $76	62%
Mclaren Health Advantage	$32 - $62	79%
Humana	$34 - $104	84%
Meritain Health	$34 - $106	84%
Aetna	$38 - $101	94%
Blue Care Network	$38 - $80	94%
Health Alliance Plan Of Michigan	$38 - $74	94%
Mclaren Advantage	$38	94%
Molina Healthplan	$38	94%
Physicians Health Plan Advantage/Advantage Plus	$38	94%
Multiplan	$40 - $124	99%
Cigna	$76	188%

Self-Pay Upfront Cash Action Plan

Request a "Self-Pay classification" with the billing desk before receiving care.
Ask for a written "Prompt-Pay Discount" agreement quoting the price of $97.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 97761.

Insurance In-Network Protection Plan

Contact your insurance company to confirm Covenant Medical Center is fully in-network.
Ask your insurer if "Prior Authorization" is required for CPT code 97761.
Confirm the specific physician or imaging center is also in-network (not just the hospital building).
Audit your Explanation of Benefits (EOB) against the final itemized hospital invoice.