CMS Price Transparency Data

Prosthetic fitting and training

Facility: El Paso Children's Hospital

Billing Code: 97761 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97761
Insurance Median: $54
Cash Discount Price: $19
vs. Medicare Baseline: 1.34x Medicare

The contracted insurance negotiated median rate for a Prosthetic fitting and training at El Paso Children's Hospital is $54. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $19. Compared to the federal Medicare reimbursement reference rate of $40.41, this hospital’s rate is 1.34x the Medicare baseline. Located in 4845 Alameda Avenue, El Paso, TX.

Cash / Self-Pay

$19

Average discount available for prompt cash payment at this facility.

Insurance Median

$54

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: $19 (47%)

Insurance Median: $54 (134%)

Cash: $19 (47% of Medicare)

Ins. Median: $54 (134% 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
El Paso First Health Plan	$27	67%
Amerigroup Tx	$34	84%
El Paso Health Plans	$34	84%
Point Comfort Underwriters	$34	84%
Superior	$34	84%
Uh Military Va	$36	89%
Molina Tx	$37	92%
Health Net Fed Svcs	$39	97%
Blue Cross Blue Shield	$40 - $71	99%
Western Sky	$50	124%
Aetna	$68 - $76	168%
UnitedHealthcare	$68	168%
Cigna	$75	186%
Coventry Health Care	$76	188%
Fortified Provider Network	$76	188%
Multiplan	$76	188%
Molina Nm	$151	374%

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 $19.
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 El Paso Children's 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.