CMS Price Transparency Data

Prosthetic fitting and training

Facility: Nationwide Children's Hospital Toledo, LLC

Billing Code: 97761 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97761
Insurance Median: $96
Cash Discount Price: $161
vs. Medicare Baseline: 2.38x Medicare

The contracted insurance negotiated median rate for a Prosthetic fitting and training at Nationwide Children's Hospital Toledo, LLC is $96. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $161. Compared to the federal Medicare reimbursement reference rate of $40.41, this hospital’s rate is 2.38x the Medicare baseline. Located in 2213 Cherry Street, Toledo, OH.

Cash / Self-Pay

$161

Average discount available for prompt cash payment at this facility.

Insurance Median

$96

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: $161 (398%)

Insurance Median: $96 (238%)

Cash: $161 (398% of Medicare)

Ins. Median: $96 (238% 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 238% of the Medicare baseline (a markup of 138%). 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
Blue Cross Blue Shield	$27 - $137	67%
Tricare	$36	89%
Caresource	$38 - $55	94%
Paramount	$38	94%
Aetna	$46 - $103	114%
Front Path Health Coalition	$50 - $121	124%
Molina	$52 - $96	129%
Mcclaren Health Plan	$54 - $121	134%
Mcclaren Health Plan - Michigan	$54	134%
Mmo	$67 - $94	166%
UnitedHealthcare	$96 - $135	238%
Amerihealth	$97	240%
Bchp	$97	240%
Humana	$97	240%
Cigna	$102	252%
Ohc	$134 - $187	332%
Ohio Ppo Connect	$134 - $187	332%
First Health	$206	510%

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 $161.
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 Toledo, LLC 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.