CMS Price Transparency Data

Prosthetic fitting and training

Facility: Highland District Hospital

Billing Code: 97761 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97761
Insurance Median: $55
Cash Discount Price: $84
vs. Medicare Baseline: 1.36x Medicare

The contracted insurance negotiated median rate for a Prosthetic fitting and training at Highland District Hospital is $55. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $84. Compared to the federal Medicare reimbursement reference rate of $40.41, this hospital’s rate is 1.36x the Medicare baseline. Located in 1275 North High Street, Hillsboro, OH.

Cash / Self-Pay

$84

Average discount available for prompt cash payment at this facility.

Insurance Median

$55

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: $84 (208%)

Insurance Median: $55 (136%)

Cash: $84 (208% of Medicare)

Ins. Median: $55 (136% 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
Aetna	$34 - $85	84%
Blue Cross Blue Shield	$34 - $80	84%
Humana	$34 - $93	84%
Medicare (plans)	$34 - $35	84%
UnitedHealthcare	$34	84%
Medigold	$35	87%
Highland_County_Sheriff_Dept	$52	129%
Medicaid / KanCare	$52 - $55	129%
Immergrun_Amish	$84	208%
Medben	$84	208%
Central_Benefits_Commercial	$94	233%
Cigna	$94	233%
Medical_Mutual_Commercial	$96	238%
Uhc_	$97	240%

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 $84.
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 Highland District 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.