CMS Price Transparency Data

Prosthetic fitting and training

Facility: Adena Regional Medical Center

Billing Code: 97761 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97761
Insurance Median: $154
Cash Discount Price: $113
vs. Medicare Baseline: 3.81x Medicare

The contracted insurance negotiated median rate for a Prosthetic fitting and training at Adena Regional Medical Center is $154. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $113. Compared to the federal Medicare reimbursement reference rate of $40.41, this hospital’s rate is 3.81x the Medicare baseline. Located in 272 Hospital Road, Chillicothe, OH.

Cash / Self-Pay

$113

Average discount available for prompt cash payment at this facility.

Insurance Median

$154

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: $113 (280%)

Insurance Median: $154 (381%)

Cash: $113 (280% of Medicare)

Ins. Median: $154 (381% 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 381% of the Medicare baseline (a markup of 281%). 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
Aetna	$38 - $162	94%
Buckeye Community Health Plan	$38	94%
Humana	$38 - $215	94%
Medical Mutual Of Ohio	$38 - $149	94%
Medigold	$38	94%
Molina	$38	94%
UnitedHealthcare	$38 - $163	94%
Care Source	$39	97%
Gateway Health	$39	97%
Molina Marketplace	$63	156%
Care Source Just4Me	$69	171%
Cigna	$81 - $140	200%
Blue Cross Blue Shield	$103 - $144	255%
Sidecar Health	$105	260%
Ohio Ppo Connect	$159	393%
The Health Plan	$159	393%
First Health	$178	440%
Ohio Health Choice	$180	445%
Healthsmart	$193	478%
Integrated Health Plan	$215	532%
Multiplan/Private Healthcare Systems	$215	532%
Three Rivers Network	$215	532%

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 $113.
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 Adena Regional Medical 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.