CMS Price Transparency Data

Prosthetic fitting and training

Facility: Sweeny Community Hospital

Billing Code: 97761 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97761
Insurance Median: $28
Cash Discount Price: $23
vs. Medicare Baseline: 0.69x Medicare

The contracted insurance negotiated median rate for a Prosthetic fitting and training at Sweeny Community Hospital is $28. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $23. Compared to the federal Medicare reimbursement reference rate of $40.41, this hospital’s rate is 0.69x the Medicare baseline. Located in 305 North McKinney, Sweeny, TX.

Cash / Self-Pay

$23

Average discount available for prompt cash payment at this facility.

Insurance Median

$28

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: $23 (57%)

Insurance Median: $28 (69%)

Cash: $23 (57% of Medicare)

Ins. Median: $28 (69% 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	$12 - $20	30%
Evercare Mcaid	$20	49%
UnitedHealthcare	$21 - $220	52%
Aetna	$23 - $31	57%
Amerigroup Mcr Adv - All Other Plans	$23	57%
Care Improvement Mcr - All Plans	$23	57%
Choicecare Mcr Adv - All Plans	$23	57%
Community Hlth Choice Him - All Other Plans	$23	57%
Coventry Mcr Adv	$23	57%
Molina Mcr Adv - All Other Plans	$23	57%
Superior Hp Mcr Adv-All Other Plans	$23	57%
Wellcare Mcare - All Plans	$23	57%
Community Hlth Choice Star	$28	69%
Molina Mcaid	$28	69%
Superior Hp Mcaid	$28	69%
Tx Chlidrens Hp Mcaid - All Plans	$28	69%
Tx True Choice Mcaid - All Plans	$28	69%
Beech Street - All Plans	$29	72%
Community Care Network - All Plans	$31	77%
Galaxy Health Network - All Plans	$35	87%
Multiplan - All Plans	$35	87%
Evercare Mcr Adv - All Other Plans	$38	94%
Amerigroup Mcaid	$39	97%
Cigna	$120	297%

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 $23.
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 Sweeny 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.