CMS Price Transparency Data

Prosthetic fitting and training

Facility: Boston Medical Center

Billing Code: 97761 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97761
Insurance Median: $50
Cash Discount Price: $144
vs. Medicare Baseline: 1.24x Medicare

The contracted insurance negotiated median rate for a Prosthetic fitting and training at Boston Medical Center is $50. 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 1.24x the Medicare baseline. Located in 1 Boston Medical Center Place, Boston, MA.

Cash / Self-Pay

$144

Average discount available for prompt cash payment at this facility.

Insurance Median

$50

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: $50 (124%)

Cash: $144 (356% of Medicare)

Ins. Median: $50 (124% 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
Workers Comp [5002]	$23	57%
Zzzbu Employee Work Comp [5004]	$23	57%
Zzzcity Of Boston Work Comp [5003]	$23	57%
Aetna	$46 - $157	114%
Blue Cross Blue Shield	$46 - $216	114%
Humana	$46	114%
Medicare (plans)	$46 - $48	114%
Neighborhood Pace [1206]	$46	114%
Oxford Health [1007]	$46	114%
Oxford Health [2024]	$46	114%
Tufts [8002]	$46 - $136	114%
Ubh Hphc [8016]	$46	114%
United [2025]	$46 - $145	114%
UnitedHealthcare	$46	114%
Veterans Admin [9003]	$46	114%
Zzzcovid19 Hrsa Uninsured Testing And Treatment Fund [500010]	$46	114%
Zzzunited [1008]	$46 - $145	114%
Wellcare [1240]	$47	116%
Cca [1215]	$48	119%
Corrections [9001]	$48 - $57	119%
Eternalhealth [1227]	$48	119%
Unicare [8004]	$48	119%
Wellpoint [2034]	$48	119%
Zzzcca Onecare [1216]	$48	119%
Fallon Sco [1126]	$50	124%
Senior Whole Health [1210]	$55	136%
Fallon [8008]	$59	146%
Tufts Conncare/Qhp [8020]	$65 - $431	161%
Medicaid / KanCare	$116	287%
Uphams Corner Esp [1213]	$128	317%
Cigna	$136 - $273	337%
Harvard Pilgrim Health Care [8001]	$145	359%
Health Plans Inc [2027]	$145	359%
Zzzhealth Plans Inc [1013]	$145	359%
Meritain Health [1023]	$157	389%
Mass General Brigham Health Plan Commercial [8009]	$173	428%
Hsn Bad Debt [4003]	$513	1269%
Hsn Confidential [4007]	$513	1269%
Hsn Dental [4006]	$513	1269%
Hsn Partial [4002]	$513	1269%
Hsn [4001]	$513	1269%

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 Boston Medical 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.