CMS Price Transparency Data

Prosthetic fitting and training

Facility: Adena Pike Medical Center

Billing Code: 97761 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97761
Insurance Median: $171
Cash Discount Price: $113
vs. Medicare Baseline: 4.23x Medicare

The contracted insurance negotiated median rate for a Prosthetic fitting and training at Adena Pike Medical Center is $171. 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 4.23x the Medicare baseline. Located in 100 Dawn Lane, Waverly, OH.

Cash / Self-Pay

$113

Average discount available for prompt cash payment at this facility.

Insurance Median

$171

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: $171 (423%)

Cash: $113 (280% of Medicare)

Ins. Median: $171 (423% 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 423% of the Medicare baseline (a markup of 323%). 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	$54 - $185	134%
Blue Cross Blue Shield	$54 - $196	134%
Buckeye Community Health Plan	$54	134%
Humana	$54 - $215	134%
Medical Mutual Of Ohio	$54 - $144	134%
Medigold	$54	134%
Molina	$54	134%
Care Source	$55	136%
Gateway Health	$75	186%
Molina Marketplace	$89	220%
Care Source Just4Me	$98	243%
Sidecar Health	$150	371%
Ohio Ppo Connect	$159	393%
The Health Plan	$159	393%
Cigna	$164	406%
Medical Mutual Of Ohio Supermed	$171	423%
First Health	$178	440%
Ohio Health Choice	$180	445%
UnitedHealthcare	$195	483%
Integrated Health Plan	$213	527%
Healthsmart	$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 Pike 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.