CMS Price Transparency Data

Prosthetic fitting and training

Facility: Pender Memorial Hospital

Billing Code: 97761 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97761
Insurance Median: $81
Cash Discount Price: $69
vs. Medicare Baseline: 2.00x Medicare

The contracted insurance negotiated median rate for a Prosthetic fitting and training at Pender Memorial Hospital is $81. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $69. Compared to the federal Medicare reimbursement reference rate of $40.41, this hospital’s rate is 2.00x the Medicare baseline. Located in 507 E Fremont St, Burgaw, NC.

Cash / Self-Pay

$69

Average discount available for prompt cash payment at this facility.

Insurance Median

$81

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: $69 (171%)

Insurance Median: $81 (200%)

Cash: $69 (171% of Medicare)

Ins. Median: $81 (200% 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 200% of the Medicare baseline (a markup of 100%). 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
Humana	$30 - $163	74%
Blue Cross Blue Shield	$31 - $137	77%
Pace Of The Southern Piedmont	$31 - $51	77%
Aetna	$32 - $162	79%
Cigna	$32 - $84	79%
New Hanover Health	$32 - $52	79%
Amerihealth	$33 - $54	82%
Carolina Complete	$33 - $53	82%
Nc Department Of Public Safety	$33 - $103	82%
Wellcare	$33 - $54	82%
Ambetter / Centene	$44 - $72	109%
Liberty Health	$44 - $73	109%
Caresource North Carolina	$46 - $76	114%
Plotkin Health	$70 - $114	173%
UnitedHealthcare	$85 - $139	210%
Medcost	$87 - $159	215%
Employers Choice Network	$113 - $184	280%
Three Rivers Provider Network	$113 - $184	280%

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 $69.
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 Pender Memorial 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.