CMS Price Transparency Data

Prosthetic fitting and training

Facility: Shriners Hospitals for Children

Billing Code: 97761 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97761
Insurance Median: $79
Cash Discount Price: $388
vs. Medicare Baseline: 1.95x Medicare

The contracted insurance negotiated median rate for a Prosthetic fitting and training at Shriners Hospitals for Children is $79. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $388. Compared to the federal Medicare reimbursement reference rate of $40.41, this hospital’s rate is 1.95x the Medicare baseline. Located in 4400 Clayton Ave, Saint Louis, MO.

Cash / Self-Pay

$388

Average discount available for prompt cash payment at this facility.

Insurance Median

$79

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: $388 (960%)

Insurance Median: $79 (195%)

Cash: $388 (960% of Medicare)

Ins. Median: $79 (195% 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
Aetna	$20 - $55	49%
Medicaid / KanCare	$20	49%
Ambetter / Centene	$22 - $35	54%
Missouri Care	$35	87%
Soonercare	$35	87%
UnitedHealthcare	$40 - $180	99%
Healthchoice Of Oklahoma	$58	144%
Blue Cross Blue Shield	$101	250%
Cigna	$130	322%
Providence Health Plan	$139	344%
Healthlink	$141 - $155	349%

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 $388.
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 Shriners Hospitals for Children 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.