CMS Price Transparency Data

Prosthetic fitting and training

Facility: UMass Memorial Healthalliance Hospitals

Billing Code: 97761 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97761
Insurance Median: $90
Cash Discount Price: $144
vs. Medicare Baseline: 2.23x Medicare

The contracted insurance negotiated median rate for a Prosthetic fitting and training at UMass Memorial Healthalliance Hospitals is $90. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $144. Compared to the federal Medicare reimbursement reference rate of $40.41, this hospital’s rate is 2.23x the Medicare baseline. Located in 60 Hospital Road, Leominster, MA.

Cash / Self-Pay

$144

Average discount available for prompt cash payment at this facility.

Insurance Median

$90

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: $144 (356%)

Insurance Median: $90 (223%)

Cash: $144 (356% of Medicare)

Ins. Median: $90 (223% 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 223% of the Medicare baseline (a markup of 123%). 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
Workers Compensation [20501]	$23	57%
Champva [11001]	$42	104%
Cigna	$42 - $123	104%
Correctional Care [11003]	$42 - $66	104%
Institution [10406]	$42 - $90	104%
Medicare (plans)	$42	104%
Tufts Dual [10111]	$42	104%
Tufts Us Family [11203]	$42	104%
Aetna	$44 - $111	109%
Fallon Mcr Supp [20202]	$44	109%
Tufts Mcr [10112]	$44	109%
UnitedHealthcare	$44 - $169	109%
Blue Cross Blue Shield	$45 - $249	111%
Commonwealth Care Mcr [10115]	$46	114%
Harvard Pilgrim Mcr [10106]	$46	114%
Mgb Mcr [10124]	$46	114%
Senior Whole Health [10110]	$46	114%
Medicaid / KanCare	$69 - $97	171%
Wellpoint [11112]	$71	176%
Hne [11108]	$74 - $94	183%
Tufts Connectorcare [10507]	$74	183%
Fallon Connectorcare [10503]	$95 - $122	235%
First Health Network [11120]	$99 - $127	245%
Multiplan [11109]	$99 - $127	245%
Tufts [11201]	$111	275%
Connecticare [11105]	$132 - $169	327%
Fallon Carelon Hlth [28]	$132 - $169	327%
Fallon Mcaid Carelon Hlth [29]	$132 - $169	327%
Grants [20507]	$132 - $169	327%
Harvard Pilgrim [10701]	$185 - $222	458%
Hsno/Free Care [10801]	$294	728%

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 $144.
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 UMass Memorial Healthalliance Hospitals 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.