CMS Price Transparency Data

Prosthetic fitting and training

Facility: North Carolina Baptist Hospital

Billing Code: 97761 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97761
Insurance Median: $127
Cash Discount Price: $191
vs. Medicare Baseline: 3.14x Medicare

The contracted insurance negotiated median rate for a Prosthetic fitting and training at North Carolina Baptist Hospital is $127. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $191. Compared to the federal Medicare reimbursement reference rate of $40.41, this hospital’s rate is 3.14x the Medicare baseline. Located in Medical Center Boulevard, Winston-Salem, NC.

Cash / Self-Pay

$191

Average discount available for prompt cash payment at this facility.

Insurance Median

$127

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: $191 (473%)

Insurance Median: $127 (314%)

Cash: $191 (473% of Medicare)

Ins. Median: $127 (314% 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 314% of the Medicare baseline (a markup of 214%). 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
Aetna	$39 - $339	97%
Apex	$39	97%
Blue Cross Blue Shield	$39 - $134	97%
Cigna	$39 - $239	97%
Devoted	$39	97%
Healthteam	$39	97%
Humana	$39 - $218	97%
Medicare (plans)	$39	97%
UnitedHealthcare	$39 - $138	97%
Wellcare	$39 - $91	97%
Liberty	$44	109%
Medcost	$72 - $265	178%
Amerihealth	$82 - $108	203%
Carolina Complete	$82 - $90	203%
Health Blue	$82 - $90	203%
Partners	$82 - $90	203%
Vaya	$83 - $91	205%
Alliance	$84 - $92	208%
Trillium	$85 - $93	210%
Ambetter / Centene	$99 - $108	245%
Oscar	$110 - $144	272%
Directnet	$216 - $236	535%
Cone Health	$256 - $279	634%
Healthgram	$256 - $279	634%
First Carolina Care	$292 - $319	723%
Private Healthcare Systems	$299 - $327	740%
Multiplan	$328 - $359	812%

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 $191.
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 North Carolina Baptist Hospital 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.