CMS Price Transparency Data
Prosthetic fitting and training
Facility: Mount Carmel St Ann's
Billing Code: 97761 (CPT)
Factual Cost Summary (Answer Capsule)
- CPT Billing Code: 97761
- Insurance Median: $65
- Cash Discount Price: $91
- vs. Medicare Baseline: 1.61x Medicare
The contracted insurance negotiated median rate for a Prosthetic fitting and training at Mount Carmel St Ann's is $65. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $91. Compared to the federal Medicare reimbursement reference rate of $40.41, this hospital’s rate is 1.61x the Medicare baseline. Located in 500 South Cleveland Avenue, Westerville, OH.
Cash / Self-Pay
$91
Average discount available for prompt cash payment at this facility.
Insurance Median
$65
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: $91 (225%)
Insurance Median: $65 (161%)
Cash: $91 (225% of Medicare)
Ins. Median: $65 (161% 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.
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Commercial Insurance Negotiated Rates
Negotiated contract ranges established by major commercial carriers at this facility.
| Carrier / Plan Group | Contract Rate Range | vs. Medicare Reference |
|---|---|---|
| Medicare (plans) | $34 - $41 | 84% |
| Aetna | $38 - $140 | 94% |
| Blue Cross Blue Shield | $38 - $140 | 94% |
| The Health Plan | $39 - $92 | 97% |
| UnitedHealthcare | $39 - $283 | 97% |
| Blue Benefit Administrators Of Massachusetts | $50 | 124% |
| Blue Care Network | $50 | 124% |
| Blue Distinction Transplant | $50 | 124% |
| Blue Shield - Ca | $50 | 124% |
| Blue Shield - Id (Regence) | $50 | 124% |
| Blue Shield - Ny Highmark Northeastern | $50 | 124% |
| Blue Shield - Ny Highmark Western | $50 | 124% |
| Blue Shield - Pa (Highmark) | $50 | 124% |
| Blue Shield - Wa (Regence) | $50 | 124% |
| Geha | $63 - $283 | 156% |
| Gravie Admin Services | $63 | 156% |
| Healthez | $63 | 156% |
| Meritain | $63 | 156% |
| Webtpa | $63 | 156% |
| Hospice Mount Carmel | $64 | 158% |
| Oscar | $64 | 158% |
| Access Health | $65 | 161% |
| Acclaim | $65 | 161% |
| Administrative Concepts | $65 | 161% |
| Allegeant | $65 | 161% |
| Allied Benefit Systems | $65 | 161% |
| American Family | $65 | 161% |
| American Healthcare Alliance | $65 | 161% |
| American National | $65 | 161% |
| American Republic | $65 | 161% |
| Amerihealth | $65 | 161% |
| Aultcare | $65 | 161% |
| Automated Benefit Services | $65 | 161% |
| Auxiant | $65 | 161% |
| Benefit Administrative Systems,Llc | $65 | 161% |
| Boon Chapman | $65 | 161% |
| Cam Administrative Services | $65 | 161% |
| Christian Brother Services | $65 | 161% |
| Christian Brothers Holy Cross | $65 | 161% |
| Claimchoice Adminstrators | $65 | 161% |
| Comprehensive Benefits | $65 | 161% |
| Continental Life Insurance | $65 | 161% |
| Coventry | $65 | 161% |
| Custom Benefit Administrators | $65 | 161% |
| Cypress Benefit Administrators | $65 | 161% |
| Employee Benefit Concepts | $65 | 161% |
| Employee Benefit Management | $65 | 161% |
| Forest County Potawatomi | $65 | 161% |
| Freedom Life Insurance Company | $65 | 161% |
| Group Administrators | $65 | 161% |
| Group Marketing Services | $65 | 161% |
| Group Pension Administrators | $65 | 161% |
| Guardian | $65 | 161% |
| Health America | $65 | 161% |
| Health Choices | $65 | 161% |
| Healthcare Management Admin | $65 | 161% |
| Insight | $65 | 161% |
| Intercare | $65 | 161% |
| Jfp Benefit Management | $65 | 161% |
| Jp Farley Corporation | $65 | 161% |
| Key Benefit Administrator | $65 | 161% |
| Liberty Union Life Assurance Co | $65 | 161% |
| Lucent Health | $65 | 161% |
| Luminare Health | $65 | 161% |
| Magnacare | $65 | 161% |
| Medcost | $65 | 161% |
| Mutual Health Services | $65 | 161% |
| Mutual Of Omaha | $65 | 161% |
| Ncas | $65 | 161% |
| Nippon Life Ins | $65 | 161% |
| Nova | $65 | 161% |
| Painters Union Insurance Fund | $65 | 161% |
| Physicians Mutual | $65 | 161% |
| Plumbers Local 98 Insurance Fund | $65 | 161% |
| Prairie States | $65 | 161% |
| Preferred One | $65 | 161% |
| Primary Physician Care | $65 | 161% |
| Professional Benefit Administrators | $65 | 161% |
| Secureone Preferred United Plans | $65 | 161% |
| Siho Insurance Services | $65 | 161% |
| Sisco Benefits | $65 | 161% |
| The Loomis Company | $65 | 161% |
| Trustmark Small Business Benefits | $65 | 161% |
| U Of M Health Plan | $65 | 161% |
| Unicare | $65 | 161% |
| Unified Group Services | $65 | 161% |
| Us Health And Life | $65 | 161% |
| Valenz | $65 | 161% |
| Varipro | $65 | 161% |
| Wps | $65 | 161% |
| Medical Mutual | $70 - $111 | 173% |
| Humana | $72 - $140 | 178% |
| Enterprise Group Planning | $74 | 183% |
| First Health | $74 | 183% |
| Paramount Hmo | $74 | 183% |
| Rural Carrier Health Benefit Plan | $80 | 198% |
| Custom Design Benefits | $81 | 200% |
| Medben | $84 - $105 | 208% |
| Consociate | $86 | 213% |
| Health Ohio Network | $86 | 213% |
| Quality Care Partners | $87 | 215% |
| Caresource | $102 | 252% |
| Western & Southern Financial Group | $102 | 252% |
| Healthlink Inc | $105 | 260% |
| Medical Benefits Mutual | $105 | 260% |
| Ohio Health Choice | $105 | 260% |
| Ohio Ppo Connect | $105 | 260% |
| Ameriben | $112 | 277% |
| Luminare Health (Detroit) | $112 | 277% |
| Medi Share | $112 | 277% |
| Multiplan | $112 | 277% |
| Ohiohealthy | $112 | 277% |
| Osu Not Independent Choice | $112 | 277% |
| Phcs | $112 | 277% |
| Philadelphia American Life Insurance | $112 | 277% |
| Twin Valley Psychiatric | $112 | 277% |
| Health Smart | $119 | 294% |
| Bccp | $140 | 346% |
| Medicaid / KanCare | $140 | 346% |
| Optima Health | $140 | 346% |
| American Postal Workers Secondary | $232 | 574% |
| Cigna | $232 | 574% |
| Health Partners | $232 | 574% |
| Healthgram | $232 | 574% |
| Mvp | $232 | 574% |
| Priority Health | $232 | 574% |
| Crime Victim Assistance | $632 | 1564% |
| Ohio Safe Program | $632 | 1564% |