CMS Price Transparency Data

Prosthetic fitting and training

Facility: UPMC Children's Hospital of Pittsburgh

Billing Code: 97761 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97761
Insurance Median: $232
Cash Discount Price: $278
vs. Medicare Baseline: 5.74x Medicare

The contracted insurance negotiated median rate for a Prosthetic fitting and training at UPMC Children's Hospital of Pittsburgh is $232. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $278. Compared to the federal Medicare reimbursement reference rate of $40.41, this hospital’s rate is 5.74x the Medicare baseline. Located in One Children's Hospital Drive, Pittsburgh, PA.

Cash / Self-Pay

$278

Average discount available for prompt cash payment at this facility.

Insurance Median

$232

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: $278 (688%)

Insurance Median: $232 (574%)

Cash: $278 (688% of Medicare)

Ins. Median: $232 (574% 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 574% of the Medicare baseline (a markup of 474%). 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	$32 - $255	79%
Upmc Health Plan	$97 - $120	240%
UnitedHealthcare	$103 - $218	255%
Blue Cross Blue Shield	$144 - $232	356%
Geisinger	$209 - $255	517%
Cigna	$218 - $255	539%
Health Plan Of Upper Ohio Valley	$302	747%
Intergroup	$302 - $394	747%
Coventry/First Health	$371	918%
Saudi Armed Forces	$371	918%
Health Payors Organization	$394	975%
Multiplan	$394	975%
National Provider Network	$418	1034%
Private Health Care Systems	$418	1034%

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 $278.
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 UPMC Children's Hospital of Pittsburgh 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.