CMS Price Transparency Data

Prosthetic fitting and training

Facility: Southwest General Health Center

Billing Code: 97761 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97761
Insurance Median: $90
Cash Discount Price: $131
vs. Medicare Baseline: 2.23x Medicare

The contracted insurance negotiated median rate for a Prosthetic fitting and training at Southwest General Health Center is $90. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $131. Compared to the federal Medicare reimbursement reference rate of $40.41, this hospital’s rate is 2.23x the Medicare baseline. Located in 18697 Bagley Road, Middleburg Heights, OH.

Cash / Self-Pay

$131

Average discount available for prompt cash payment at this facility.

Insurance Median

$90

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: $131 (324%)

Insurance Median: $90 (223%)

Cash: $131 (324% of Medicare)

Ins. Median: $90 (223% 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 223% of the Medicare baseline (a markup of 123%). 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
Medical Mutual	$22 - $25	54%
Medical Mutual-Ohio	$22	54%
Healthsmart	$53 - $59	131%
Health Design Plus	$61 - $68	151%
Humana	$65 - $116	161%
Clarity Health	$66 - $74	163%
Healthspan	$66 - $74	163%
Buckeye	$71 - $116	176%
Molina	$71 - $116	176%
Healthsmart Preferred	$75 - $83	186%
Ohio Health Choice Plus	$80 - $89	198%
Aetna	$90 - $100	223%
Summacare	$90 - $99	223%
UnitedHealthcare	$90 - $116	223%
Coventry	$115 - $127	285%
First Health	$115 - $127	285%
Amerihealth Caritas	$116	287%
Blue Cross Blue Shield	$116	287%
Caresource	$116	287%
Ohio Health Choice	$128 - $142	317%
Private Healthare Systems	$133 - $147	329%
Cigna	$184	455%

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 $131.
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 Southwest General Health Center 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.