CMS Price Transparency Data

Prosthetic fitting and training

Facility: The Women's Hospital

Billing Code: 97761 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97761
Insurance Median: $106
Cash Discount Price: $186
vs. Medicare Baseline: 2.62x Medicare

The contracted insurance negotiated median rate for a Prosthetic fitting and training at The Women's Hospital is $106. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $186. Compared to the federal Medicare reimbursement reference rate of $40.41, this hospital’s rate is 2.62x the Medicare baseline. Located in 4199 Gateway Blvd, Newburgh, IN.

Cash / Self-Pay

$186

Average discount available for prompt cash payment at this facility.

Insurance Median

$106

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: $186 (460%)

Insurance Median: $106 (262%)

Cash: $186 (460% of Medicare)

Ins. Median: $106 (262% 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 262% of the Medicare baseline (a markup of 162%). 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
Aetna	$30 - $335	74%
Humana	$30 - $116	74%
Passport Molina Ky	$30 - $116	74%
UnitedHealthcare	$30 - $402	74%
Wellcare Ky	$30 - $116	74%
Immergrun	$47 - $210	116%
Encorecombined	$51 - $352	126%
Encoreprime	$51 - $342	126%
Chamber Care	$58 - $352	144%
Iu Health	$64 - $251	158%
Blue Cross Blue Shield	$67 - $140	166%
Self Pay	$76 - $297	188%
Ambetter / Centene	$77 - $301	191%
Patoka Valley Health Care (90/10 Plan)	$77 - $302	191%
Patoka Valley Health Care (80/20 Plan)	$80 - $312	198%
Alliance Coal	$89 - $349	220%
Claritev (Formerly Phcs/Mulitplan)	$89 - $347	220%
One Care	$90 - $352	223%
Cigna	$93 - $362	230%
Sagamore	$93 - $362	230%
First Health/Coventry	$95 - $372	235%
Center Care	$100 - $392	247%
Healthlink	$103 - $428	255%

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 $186.
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 The Women's 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.