CMS Price Transparency Data

Prosthetic fitting and training

Facility: Texas Health Presbyterian Hospital Allen

Billing Code: 97761 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97761
Insurance Median: $122
Cash Discount Price: $110
vs. Medicare Baseline: 3.02x Medicare

The contracted insurance negotiated median rate for a Prosthetic fitting and training at Texas Health Presbyterian Hospital Allen is $122. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $110. Compared to the federal Medicare reimbursement reference rate of $40.41, this hospital’s rate is 3.02x the Medicare baseline. Located in 1105 Central Expressway North, Allen, TX.

Cash / Self-Pay

$110

Average discount available for prompt cash payment at this facility.

Insurance Median

$122

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: $110 (272%)

Insurance Median: $122 (302%)

Cash: $110 (272% of Medicare)

Ins. Median: $122 (302% 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 302% of the Medicare baseline (a markup of 202%). 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
Amerigroup	$21 - $41	52%
Blue Cross Blue Shield	$21 - $343	52%
Parkland	$21	52%
UnitedHealthcare	$21 - $401	52%
Superior Wellcare	$22 - $43	54%
Molina	$23 - $41	57%
American Health	$39	97%
Healthspring	$40	99%
Humana	$41	101%
Aetna	$75 - $128	186%
City Of Fort Worth	$86	213%
Fort Worth Firefighters	$112 - $250	277%
Quick Trip	$130	322%
Healthsmart	$137 - $154	339%
Phcs	$153	379%
Multiplan	$159	393%
Galaxy	$161	398%
Usa	$161	398%
Cigna	$172 - $396	426%

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 $110.
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 Texas Health Presbyterian Hospital Allen 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.