CMS Price Transparency Data

Prosthetic fitting and training

Facility: Waverly Health Center

Billing Code: 97761 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97761
Insurance Median: $61
Cash Discount Price: $70
vs. Medicare Baseline: 1.51x Medicare

The contracted insurance negotiated median rate for a Prosthetic fitting and training at Waverly Health Center is $61. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $70. Compared to the federal Medicare reimbursement reference rate of $40.41, this hospital’s rate is 1.51x the Medicare baseline. Located in 312 9Th Street Sw, Waverly, IA.

Cash / Self-Pay

$70

Average discount available for prompt cash payment at this facility.

Insurance Median

$61

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: $70 (173%)

Insurance Median: $61 (151%)

Cash: $70 (173% of Medicare)

Ins. Median: $61 (151% 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
Choicecare Network - All Plans	$29 - $54	72%
UnitedHealthcare	$29 - $99	72%
Medicare (plans)	$33 - $61	82%
Midlands Choice Mcare	$33 - $61	82%
Health Alliance-All Plans	$38 - $127	94%
Midlands Choice-All Other Plans	$47 - $127	116%
Hlth Partners Bridges Ntwrk	$53 - $98	131%
Hlth Partners Open Ntwrk - All Other Plans	$53 - $98	131%
Wellmark Hmo	$61 - $179	151%
Wellmark Ppo - All Other Plans	$61 - $196	151%
Aetna	$65 - $120	161%

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 $70.
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 Waverly Health 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.