Prosthetic fitting and training
Facility: Medstar Harbor Hospital
Billing Code: 97761 (CPT)
- CPT Billing Code: 97761
- Insurance Median: $271
- Cash Discount Price: $265
- vs. Medicare Baseline: 6.71x Medicare
Average discount available for prompt cash payment at this facility.
Median negotiated contract rate across all mapped commercial carriers.
Standard federal government reimbursement rate for this code.
Visual Cost Comparison vs. 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 671% of the Medicare baseline (a markup of 571%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.
Out-of-Pocket Cost Estimator
Estimate whether it is more economical to use your insurance or pay the upfront self-pay cash rate.
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 | $166 - $301 | 411% |
| Amerigroup | $166 - $301 | 411% |
| Amerihealth Caritas District Of Columbia | $166 - $301 | 411% |
| Carefirst Advantage Inc | $166 - $301 | 411% |
| Carefirst Blue Choice Inc | $166 - $301 | 411% |
| Cigna | $166 - $301 | 411% |
| First Health | $166 - $301 | 411% |
| Hscsn | $166 - $301 | 411% |
| Humana | $166 - $301 | 411% |
| Kaiser Permanente | $166 - $301 | 411% |
| Magellan Behavioral Health Inc | $166 - $301 | 411% |
| Mamsi | $166 - $301 | 411% |
| Medstar Family Choice | $166 - $301 | 411% |
| Medstar Family Choice Inc | $166 - $301 | 411% |
| Ncppo Healthlink Ppo | $166 - $301 | 411% |
| Pfc | $166 - $301 | 411% |
| Private Healthcare Systems (Phcs) | $166 - $301 | 411% |
| Tricare | $166 - $301 | 411% |
| United Behavioral Health Inc | $166 - $301 | 411% |
| UnitedHealthcare | $166 - $301 | 411% |
Consumer Guidance & Cost Commentary
For the CPT code 97761 (Prosthetic fitting and training) at Medstar Harbor Hospital in Baltimore, the cash median price is $265. This facility is a voluntary non-profit acute care hospital located at 3001 South Hanover Street. While the facility lists a gross charge of $271 and a median negotiated rate of $271, patients should be aware that paying cash directly can sometimes result in a lower out-of-pocket cost than using insurance, particularly if their plan has a high deductible or if the negotiated rate exceeds the cash price. It is always advisable to ask the hospital about "self-pay" or "prompt-pay" discounts before scheduling services to ensure you are receiving the most favorable rate available.
The Medicare amount for this service is $40.41, which serves as a key benchmark for understanding the facility's pricing markup relative to federal standards. Although specific state or county average data was not provided in this report, the significant difference between the Medicare rate and the facility's cash and negotiated rates highlights the importance of comparing commercial rates against the government baseline. Patients should avoid accepting summary bills without requesting a detailed, itemized CPT-coded statement to identify any errors, unbundled charges, or services not rendered. Furthermore, if you receive a balance bill from an out-of-network provider at this in-network facility, you may be entitled to protections under the No Surprises Act, and you should dispute any unexpected charges in writing rather than paying immediately.