CMS Price Transparency Data

Prosthetic fitting and training

Facility: Piedmont Mountainside Hospital Inc

Billing Code: 97761 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97761
Insurance Median: $152
Cash Discount Price: $61
vs. Medicare Baseline: 3.76x Medicare

The contracted insurance negotiated median rate for a Prosthetic fitting and training at Piedmont Mountainside Hospital Inc is $152. 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 3.76x the Medicare baseline. Located in 1266 Highway 515 South, Jasper, GA.

Cash / Self-Pay

$61

Average discount available for prompt cash payment at this facility.

Insurance Median

$152

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: $152 (376%)

Cash: $61 (151% of Medicare)

Ins. Median: $152 (376% 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 376% of the Medicare baseline (a markup of 276%). 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 - $24	52%
Blue Cross Blue Shield	$88 - $97	218%
First Health [10303]	$138 - $146	341%
Aetna	$140 - $148	346%
Novanet [10819]	$148 - $156	366%
Beechstreet [10800]	$158 - $166	391%
Phcs [10601]	$158 - $166	391%
Kaiser [10500]	$168 - $177	416%
Multiplan [10600]	$168 - $177	416%
Alliant Health Plans Of Georgia [10952]	$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 Mountainside Hospital Inc 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.