CMS Price Transparency Data

Prosthetic fitting and training

Facility: Nationwide Children's Hospital

Billing Code: 97761 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97761
Insurance Median: $108
Cash Discount Price: $103
vs. Medicare Baseline: 2.67x Medicare

The contracted insurance negotiated median rate for a Prosthetic fitting and training at Nationwide Children's Hospital is $108. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $103. Compared to the federal Medicare reimbursement reference rate of $40.41, this hospital’s rate is 2.67x the Medicare baseline. Located in 700 Children's Drive, Columbus, OH.

Cash / Self-Pay

$103

Average discount available for prompt cash payment at this facility.

Insurance Median

$108

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: $103 (255%)

Insurance Median: $108 (267%)

Cash: $103 (255% of Medicare)

Ins. Median: $108 (267% 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 267% of the Medicare baseline (a markup of 167%). 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
Tricare	$36	89%
Blue Cross Blue Shield	$58 - $131	144%
Caresource	$58 - $131	144%
UnitedHealthcare	$74 - $131	183%
Aetna	$83 - $152	205%
Humana	$91 - $131	225%
Ohg	$103 - $152	255%
Ohio Ppo Connect	$104 - $115	257%
Osu	$104 - $115	257%
Ohc	$106 - $152	262%
Ahpo	$107	265%
Cigna	$107 - $152	265%
Front Path Health Coalition	$107 - $152	265%
Mmo	$107 - $146	265%
Unicare	$108	267%
The Health Plan	$109 - $152	270%
Emerald Health	$112	277%
First Health	$112	277%
Phcs	$112	277%
Amerihealth	$131	324%
Bchp	$131	324%
Molina	$131	324%

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 $103.
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 Nationwide Children's 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.