CMS Price Transparency Data

Prosthetic fitting and training

Facility: Woodlawn Hospital

Billing Code: 97761 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97761
Insurance Median: $115
Cash Discount Price: $118
vs. Medicare Baseline: 2.85x Medicare

The contracted insurance negotiated median rate for a Prosthetic fitting and training at Woodlawn Hospital is $115. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $118. Compared to the federal Medicare reimbursement reference rate of $40.41, this hospital’s rate is 2.85x the Medicare baseline. Located in 1400 E 9Th St, Rochester, IN.

Cash / Self-Pay

$118

Average discount available for prompt cash payment at this facility.

Insurance Median

$115

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: $118 (292%)

Insurance Median: $115 (285%)

Cash: $118 (292% of Medicare)

Ins. Median: $115 (285% 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 285% of the Medicare baseline (a markup of 185%). 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	$34 - $151	84%
Blue Cross Blue Shield	$34 - $159	84%
Caresource Mcaid Hip	$34 - $35	84%
Caresource Mcr Adv	$34 - $35	84%
Humana	$34 - $123	84%
Mdwise Mcaid Excel Hip	$34 - $35	84%
Mhs Exch Mrktplce-All Other Plans	$34 - $35	84%
Mhs Mcaid Hip	$34 - $35	84%
UnitedHealthcare	$34 - $159	84%
Mhs Mcr Adv	$35 - $36	87%
Caresource Exch - All Other Plans	$45	111%
Ambetter / Centene	$46 - $47	114%
Partners Direct Health-All Plans	$106 - $108	262%
Cigna	$112 - $135	277%
Parkview Health Plans-All Plans	$117 - $119	290%
Sagamore All Other Grps - All Other Plans	$131 - $134	324%
Encore Comm-All Plans	$133 - $135	329%
Phcs/Multiplan-All Plans	$145 - $148	359%
Community Health Alliance-All Plans	$148 - $151	366%
Caresource Mcaid Hww	$156 - $159	386%
Mhs Mcaid Hcc	$156 - $159	386%
Mhs Mcaid Hhw	$156 - $159	386%

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 $118.
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 Woodlawn 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.