CMS Price Transparency Data

Prosthetic fitting and training

Facility: UNM Hospital

Billing Code: 97761 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97761
Insurance Median: $39
Cash Discount Price: $47
vs. Medicare Baseline: 0.97x Medicare

The contracted insurance negotiated median rate for a Prosthetic fitting and training at UNM Hospital is $39. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $47. Compared to the federal Medicare reimbursement reference rate of $40.41, this hospital’s rate is 0.97x the Medicare baseline. Located in 2211 Lomas Boulevard Ne, Albuquerque, NM.

Cash / Self-Pay

$47

Average discount available for prompt cash payment at this facility.

Insurance Median

$39

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: $47 (116%)

Insurance Median: $39 (97%)

Cash: $47 (116% of Medicare)

Ins. Median: $39 (97% 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
Humana	$35	87%
Aetna	$39	97%
Alamo Navajo School Board	$39	97%
Blue Cross Blue Shield	$39	97%
Indian Health Abq	$39	97%
Kewa Pueblo Health Corporation	$39	97%
Pueblo Of Isleta	$39	97%
Pueblo Of Jemez	$39	97%
Pueblo Of Sandia	$39	97%
UnitedHealthcare	$39	97%
Devoted Health	$46	114%
Christus	$58	144%
Albuquerque Public Schools	$77	191%
Presbyterian Network	$77	191%
Christus Health Exchange Plan	$87	215%
Imperial Health Exchange	$94	233%
Molina	$94	233%

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 $47.
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 UNM 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.