CMS Price Transparency Data

Prosthetic fitting and training

Facility: Essentia Health

Billing Code: 97761 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97761
Insurance Median: $40
Cash Discount Price: $46
vs. Medicare Baseline: 0.99x Medicare

The contracted insurance negotiated median rate for a Prosthetic fitting and training at Essentia Health is $40. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $46. Compared to the federal Medicare reimbursement reference rate of $40.41, this hospital’s rate is 0.99x the Medicare baseline. Located in 3000 32Nd Ave South, Fargo, ND.

Cash / Self-Pay

$46

Average discount available for prompt cash payment at this facility.

Insurance Median

$40

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: $46 (114%)

Insurance Median: $40 (99%)

Cash: $46 (114% of Medicare)

Ins. Median: $40 (99% 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
Medica Access	$16	40%
Healthpartners Care Pmap	$24	59%
Sanford Health Plan	$26 - $84	64%
Blue Cross Blue Shield	$27 - $55	67%
Medica	$34 - $38	84%
Medica Uplan	$34	84%
Medica Choice	$39	97%
Advocare/Security Health	$40	99%
Freedom Blue Ppo	$40	99%
Healthpartners Care Msho / Mcr Adv	$40	99%
Imcare Msho Pcc Prime	$40	99%
Imcare Msho Ref Req	$40	99%
Medica Advantage Solutions	$40	99%
Medica Msho/Dual Solutions	$40	99%
Medica Prime Solution Group	$40	99%
Medicare (plans)	$40	99%
Nd Va Administration	$40	99%
Platinum Blue/Vantage Blue	$40	99%
Primewest Msho	$40	99%
Secure Blue Msho	$40	99%
Ubh Cost Plan	$40	99%
Ubh Msho	$40	99%
Ucare	$40	99%
Ucare Msho	$40	99%
UnitedHealthcare	$40 - $49	99%
Cigna	$41	101%
Healthpartners	$41	101%
Healthpartners Pcc Prime	$41	101%
Itasca Med Care	$41	101%
Primewest	$42	104%
Wea	$44 - $47	109%
America'S Ppo	$47	116%
Wps	$51	126%
Aetna	$52	129%

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 $46.
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 Essentia Health 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.