CMS Price Transparency Data

Prosthetic fitting and training

Facility: Gulf Breeze Hospital

Billing Code: 97761 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97761
Insurance Median: $55
Cash Discount Price: $17
vs. Medicare Baseline: 1.36x Medicare

The contracted insurance negotiated median rate for a Prosthetic fitting and training at Gulf Breeze Hospital is $55. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $17. Compared to the federal Medicare reimbursement reference rate of $40.41, this hospital’s rate is 1.36x the Medicare baseline. Located in 1110 Gulf Breeze Pkwy, Gulf Breeze, FL.

Cash / Self-Pay

$17

Average discount available for prompt cash payment at this facility.

Insurance Median

$55

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: $17 (42%)

Insurance Median: $55 (136%)

Cash: $17 (42% of Medicare)

Ins. Median: $55 (136% 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
Aetna	$13 - $151	32%
Pensacola	$17	42%
Cha Health Plan	$23	57%
UnitedHealthcare	$23 - $234	57%
Fl Community Care Ltc	$24	59%
Humana	$24 - $53	59%
Sunshine Health	$24	59%
Wellcare	$24 - $55	59%
Simply Healthcare Healthy Kids	$26	64%
Hospice Regency	$35	87%
Hospice Covenant	$52	129%
Medicare (plans)	$54	134%
Cigna	$55 - $116	136%
Hospice Emerald Coast	$58	144%
Private Healthcare	$75	186%
Uwf Athletes	$75	186%
First Health	$81	200%
Wc Corvel	$83 - $110	205%
Choicecare	$87	215%
Fl Blue	$87 - $308	215%
Multiplan	$103	255%
Bc Fl	$201	497%

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 $17.
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 Gulf Breeze Hospital 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.