CMS Price Transparency Data

Prosthetic fitting and training

Facility: Piedmont Athens Regional Medical Center

Billing Code: 97761 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97761
Insurance Median: $198
Cash Discount Price: $61
vs. Medicare Baseline: 4.90x Medicare

The contracted insurance negotiated median rate for a Prosthetic fitting and training at Piedmont Athens Regional Medical Center is $198. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $61. Compared to the federal Medicare reimbursement reference rate of $40.41, this hospital’s rate is 4.90x the Medicare baseline. Located in 1199 Prince Avenue, Athens, GA.

Cash / Self-Pay

$61

Average discount available for prompt cash payment at this facility.

Insurance Median

$198

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: $61 (151%)

Insurance Median: $198 (490%)

Cash: $61 (151% of Medicare)

Ins. Median: $198 (490% 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 490% of the Medicare baseline (a markup of 390%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.

Consult Patient Advocate

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
Medicaid / KanCare	$21 - $23	52%
Kaiser [10500]	$109 - $114	270%
First Health [10303]	$138 - $146	341%
Novanet [10819]	$148 - $156	366%
Beechstreet [10800]	$162 - $171	401%
Multiplan [10600]	$162 - $171	401%
Phcs [10601]	$162 - $171	401%
Aetna	$198 - $208	490%
Alliant Health Plans Of Georgia [10952]	$198 - $208	490%
Blue Cross Blue Shield	$198 - $208	490%
Cigna	$198 - $208	490%
UnitedHealthcare	$198 - $208	490%

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 $61.
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 Piedmont Athens Regional 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.