CMS Price Transparency Data

Prosthetic fitting and training

Facility: Southcoast Hospitals Group

Billing Code: 97761 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97761
Insurance Median: $59
Cash Discount Price: $57
vs. Medicare Baseline: 1.46x Medicare

The contracted insurance negotiated median rate for a Prosthetic fitting and training at Southcoast Hospitals Group is $59. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $57. Compared to the federal Medicare reimbursement reference rate of $40.41, this hospital’s rate is 1.46x the Medicare baseline. Located in 363 Highland Avenue, Fall River, MA.

Cash / Self-Pay

$57

Average discount available for prompt cash payment at this facility.

Insurance Median

$59

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: $57 (141%)

Insurance Median: $59 (146%)

Cash: $57 (141% of Medicare)

Ins. Median: $59 (146% 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
Wellsense Health Plan Clarity Connectorcare & Meta	$24	59%
Medicare (plans)	$28 - $55	69%
Aetna	$46 - $86	114%
Blue Cross Blue Shield	$46 - $204	114%
Evercare [1010304]	$46	114%
Tufts Senior Care Options [1010315]	$46	114%
UnitedHealthcare	$46 - $183	114%
Wellsense Health Plan Senior Care Options [1020208	$46	114%
Commonwealth Care Alliance [1080501]	$47 - $48	116%
Tufts [1010701]	$47	116%
Eternal Health [1010322]	$50	124%
Fallon [1000114]	$64	158%
Mass General Brigham Health Plan Commercial [10122	$64	158%
Mass General Brigham Health Plan Connectorcare [10	$64	158%
Group Insurance Service Center [1013001]	$68	168%
Innovative Health Plan [1025001]	$68	168%
Priority Health [1015001]	$68	168%
PHCS [1000125]	$73	181%
Cigna	$74	183%
Wellsense Health Plan [1010202]	$78	193%
Wellpoint [1000102]	$84	208%
First Health [1000130]	$86	213%
Tufts Health Public Plans [1010213]	$90 - $412	223%
Harvard Pilgrim [1010602]	$236	584%

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 $57.
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 Southcoast Hospitals Group 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.