CMS Price Transparency Data

Prosthetic fitting and training

Facility: Roxborough Memorial Hospital

Billing Code: 97761 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97761
Insurance Median: $46
Cash Discount Price: $41
vs. Medicare Baseline: 1.14x Medicare

The contracted insurance negotiated median rate for a Prosthetic fitting and training at Roxborough Memorial Hospital is $46. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $41. Compared to the federal Medicare reimbursement reference rate of $40.41, this hospital’s rate is 1.14x the Medicare baseline. Located in 5800 Ridge Ave, Philadelphia, PA.

Cash / Self-Pay

$41

Average discount available for prompt cash payment at this facility.

Insurance Median

$46

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: $41 (101%)

Insurance Median: $46 (114%)

Cash: $41 (101% of Medicare)

Ins. Median: $46 (114% 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
Humana	$33	82%
Blue Cross Blue Shield	$42 - $82	104%
Health Partners Plan	$42 - $63	104%
Medicare (plans)	$42 - $44	104%
Pa Health & Wellness	$42 - $50	104%
Tricare	$42	104%
UnitedHealthcare	$42 - $46	104%
Keystone	$43	106%
Providers Partner Health Plan	$43	106%
Spartan	$44	109%
Auto Insurance	$46	114%
Worker Compensation	$47	116%
Employer Direct Healthcare	$58	144%
Naphcare	$65	161%
Highmark	$86	213%
Cigna	$143	354%

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 $41.
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 Roxborough Memorial 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.