CMS Price Transparency Data

Prosthetic fitting and training

Facility: Portsmouth Regional Hospital

Billing Code: 97761 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97761
Insurance Median: $92
Cash Discount Price: $245
vs. Medicare Baseline: 2.28x Medicare

The contracted insurance negotiated median rate for a Prosthetic fitting and training at Portsmouth Regional Hospital is $92. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $245. Compared to the federal Medicare reimbursement reference rate of $40.41, this hospital’s rate is 2.28x the Medicare baseline. Located in 333 Borthwick Ave, Portsmouth, NH.

Cash / Self-Pay

$245

Average discount available for prompt cash payment at this facility.

Insurance Median

$92

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: $245 (606%)

Insurance Median: $92 (228%)

Cash: $245 (606% of Medicare)

Ins. Median: $92 (228% 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 228% of the Medicare baseline (a markup of 128%). 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
Amerihealth Caritas	$10	25%
Well Sense Health Plan	$20	49%
Humana	$40 - $41	99%
Martin'S Point Health	$40 - $43	99%
Aetna	$41 - $155	101%
Sierra Military Health	$41	101%
United Behavioral Health	$41	101%
United Va Ccn	$41	101%
Blue Cross Blue Shield	$42 - $109	104%
Cigna	$42	104%
Evernorth Behavioral Health	$42	104%
United	$42 - $162	104%
Ambetter / Centene	$74	183%
Maine Community Health	$77 - $130	191%
Tufts Health Plan	$92 - $140	228%
Harvard Pilgrim	$105	260%
Corvel	$176	436%
Evernorth	$196	485%
Mutual Of Omaha	$196	485%
Multiplan	$198	490%
First Health	$223	552%
Healthcare Value Mgmt	$223	552%
Oxford Health Plans	$233	577%

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 $245.
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 Portsmouth Regional 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.