CMS Price Transparency Data

Prosthetic fitting and training

Facility: Dekalb Community Hospital

Billing Code: 97761 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97761
Insurance Median: $38
Cash Discount Price: Unavailable
vs. Medicare Baseline: 0.94x Medicare

The contracted insurance negotiated median rate for a Prosthetic fitting and training at Dekalb Community Hospital is $38. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is unavailable. Compared to the federal Medicare reimbursement reference rate of $40.41, this hospital’s rate is 0.94x the Medicare baseline. Located in 520 W Main St, Smithville, TN.

Cash / Self-Pay

Unavailable

Average discount available for prompt cash payment at this facility.

Insurance Median

$38

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%)

Insurance Median: $38 (94%)

Ins. Median: $38 (94% 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
Blue Cross Blue Shield	$23 - $72	57%
Point Comfort Underwriters	$34	84%
Community Plan	$36	89%
Amerigroup Mcr Replacement	$38	94%
Ascension Complete	$38	94%
Centurion Of Tn	$38	94%
Covid Uninsured Test Fund	$38	94%
Healthspring Mcr Replacement	$38	94%
Humana	$38	94%
Medicare (plans)	$38	94%
Nhc Advantage	$38	94%
UnitedHealthcare	$38	94%
Aetna	$39	97%
Ambetter / Centene	$49	121%
Oscar Health	$53	131%
Smart Health	$53	131%
Cigna	$54 - $58	134%

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 $X.
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 Dekalb Community 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.