CMS Price Transparency Data
Prosthetic fitting and training
Facility: Saint Alphonsus Medical Center Ontario
Billing Code: 97761 (CPT)
Factual Cost Summary (Answer Capsule)
- CPT Billing Code: 97761
- Insurance Median: $34
- Cash Discount Price: $73
- vs. Medicare Baseline: 0.84x Medicare
The contracted insurance negotiated median rate for a Prosthetic fitting and training at Saint Alphonsus Medical Center Ontario is $34. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $73. Compared to the federal Medicare reimbursement reference rate of $40.41, this hospital’s rate is 0.84x the Medicare baseline. Located in 351 Sw 9Th Street, Ontario, OR.
Cash / Self-Pay
$73
Average discount available for prompt cash payment at this facility.
Insurance Median
$34
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: $73 (181%)
Insurance Median: $34 (84%)
Cash: $73 (181% of Medicare)
Ins. Median: $34 (84% 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
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Commercial Insurance Negotiated Rates
Negotiated contract ranges established by major commercial carriers at this facility.
| Carrier / Plan Group | Contract Rate Range | vs. Medicare Reference |
|---|---|---|
| Medicaid / KanCare | $19 - $34 | 47% |
| Ada County Jail Inmate Ins | $34 | 84% |
| Aetna | $34 - $107 | 84% |
| Ambetter / Centene | $34 | 84% |
| Amish Mennonite | $34 | 84% |
| Bcccp-Michigan | $34 | 84% |
| Bccp | $34 | 84% |
| Blue Cross Blue Shield | $34 - $96 | 84% |
| Bmc Healthnet | $34 | 84% |
| Breast Grant-Connecticut | $34 | 84% |
| California Health And Wellness | $34 | 84% |
| Cardinal Innovations Lme | $34 | 84% |
| Care Oregon Ohp | $34 | 84% |
| Cencal Health Plan | $34 | 84% |
| Cenpatico | $34 | 84% |
| Centurion Of Idaho | $34 | 84% |
| Chhuny | $34 | 84% |
| Childrens Comm Health Plan | $34 | 84% |
| Childrens Medical Services Title 19 | $34 | 84% |
| Cigna | $34 - $106 | 84% |
| Community Benefit Health | $34 | 84% |
| Community Care Behavorial Health | $34 | 84% |
| Community Health Choice | $34 | 84% |
| Covid19 Hrsa Uninsured Testing And Treatment Fund | $34 | 84% |
| Dean Wi Badgercare | $34 | 84% |
| Delaware First Health | $34 | 84% |
| Delta Dental Nj | $34 | 84% |
| Dph Tb Program | $34 | 84% |
| Dscc | $34 | 84% |
| Eastpointe Lme | $34 | 84% |
| Family Health Network | $34 | 84% |
| Freedom First Healthcare | $34 | 84% |
| Ghc Scw Wi Badgercare | $34 | 84% |
| Harbor Health | $34 | 84% |
| Health Safety Net | $34 | 84% |
| Healthy Blue Ne | $34 | 84% |
| Hennepin Health | $34 | 84% |
| Humana | $34 - $99 | 84% |
| Id County Ada | $34 | 84% |
| Id County Canyon | $34 | 84% |
| Id County Cat Fund | $34 | 84% |
| Id County Payette | $34 | 84% |
| Idaho Womens Health Check | $34 | 84% |
| Indiana Breast Cervical Cancer | $34 | 84% |
| Inland Empire Health Plan | $34 | 84% |
| Intercommunity Health Ohp | $34 | 84% |
| Iowa Total Care | $34 | 84% |
| Jai Medical System | $34 | 84% |
| Kern Family Health Plan | $34 | 84% |
| Keystone First | $34 | 84% |
| Keystone First Chip | $34 | 84% |
| La Care Health Plan | $34 | 84% |
| Lakeland Care Inc | $34 | 84% |
| Managed Health Services - Indiana | $34 | 84% |
| Maryland Breast & Cervical Program | $34 | 84% |
| Maryland Healthy Smiles - Scion Dental | $34 | 84% |
| Maryland Physicians Care | $34 | 84% |
| Massachusetts Behavioral Health Partnership | $34 | 84% |
| Mdwise | $34 | 84% |
| Medi-Cal | $34 | 84% |
| Medi-Cal Healthnet | $34 | 84% |
| Medstar Dc Healthy Family | $34 | 84% |
| Medstar Md Health Choice | $34 | 84% |
| Mo Home State Health Plan | $34 | 84% |
| Molina Centennial Care | $34 | 84% |
| Nascentia Health Options | $34 | 84% |
| Nebraska Total Care | $34 | 84% |
| New York Cancer Services Program | $34 | 84% |
| Nextlevel Health | $34 | 84% |
| Oregon Screenwise | $34 | 84% |
| Pace Of Southwest Michigan | $34 | 84% |
| Paramount Advantage | $34 | 84% |
| Parkland Community Health Plan | $34 | 84% |
| Partners Behavioral Lme | $34 | 84% |
| Peach State Healthplan | $34 | 84% |
| Presbyterian Centennial Care | $34 | 84% |
| Prestige Health Choice | $34 | 84% |
| Priority Partners | $34 | 84% |
| Rx 340B Pass Along | $34 | 84% |
| Rx Assistance/Rx Manufacturer Assistance 0 Copay | $34 | 84% |
| Rx Medi-Cal | $34 | 84% |
| Rx Meridian Rx | $34 | 84% |
| Sandhills Center Lme | $34 | 84% |
| Screening For Life | $34 | 84% |
| Sunshine State Health Plan | $34 | 84% |
| Superior Health | $34 | 84% |
| Tenncare | $34 | 84% |
| Texas Children'S Health Plan | $34 | 84% |
| Trillium Community Ohp | $34 | 84% |
| Tufts Health Public Plans | $34 | 84% |
| UnitedHealthcare | $34 - $108 | 84% |
| Vaya Health Lme | $34 | 84% |
| Wellsense Health Plan | $34 | 84% |
| Wi Womens Wellness | $34 | 84% |
| Medicare (plans) | $40 - $42 | 99% |
| American Health Advantage Of Idaho | $41 | 101% |
| Selecthealth | $53 - $102 | 131% |
| Blue Benefit Administrators Of Massachusetts | $65 | 161% |
| Blue Care Network | $65 | 161% |
| Blue Distinction Transplant | $65 | 161% |
| Blue Shield - Ca | $65 | 161% |
| Blue Shield - Id (Regence) | $65 | 161% |
| Blue Shield - Ny Highmark Northeastern | $65 | 161% |
| Blue Shield - Ny Highmark Western | $65 | 161% |
| Blue Shield - Pa (Highmark) | $65 | 161% |
| Blue Shield - Wa (Regence) | $65 | 161% |
| Healthcare Management Admin | $67 | 166% |
| Mountain Health Co-Op | $68 | 168% |
| Pacificsource Health Plans | $68 - $106 | 168% |
| Moda Health | $75 - $110 | 186% |
| Allegiance | $86 | 213% |
| Correctional Health Partners | $88 | 218% |
| Columbia Health Network | $90 | 223% |
| Healthnet | $95 | 235% |
| Allied National Global Care | $102 | 252% |
| Asrm - Reliance Standard Life Insurance | $102 | 252% |
| Christian Care Ministry | $102 | 252% |
| Dean Health | $102 | 252% |
| Fallon Health | $102 | 252% |
| Family Life Insurance Company | $102 | 252% |
| First Choice Health | $102 | 252% |
| Ghc Scw | $102 | 252% |
| International Benefit Administrators | $102 | 252% |
| Lifetime Benefit Solutions | $102 | 252% |
| Manhattan Life | $102 | 252% |
| Pai | $102 | 252% |
| Pan-American Life | $102 | 252% |
| Paramount Hmo | $102 | 252% |
| Phcs | $102 | 252% |
| Trinity Health Share | $102 | 252% |
| Webtpa | $102 - $107 | 252% |
| Lifewise | $105 | 260% |
| Priority Health | $106 | 262% |
| Allied Benefit Systems | $107 | 265% |
| Ameriben | $107 | 265% |
| Asr Health Benefits | $107 | 265% |
| Christian Brother Services | $107 | 265% |
| First Health | $107 | 265% |
| Geha | $107 - $108 | 265% |
| Healthez | $107 | 265% |
| Luminare Health (Detroit) | $107 | 265% |
| Medi Share | $107 | 265% |
| Providence | $107 | 265% |
| Rural Carrier Health Benefit Plan | $107 | 265% |