CMS Price Transparency Data

Prosthetic fitting and training

Facility: Ascension Seton Hays

Billing Code: 97761 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97761
Insurance Median: $39
Cash Discount Price: $55
vs. Medicare Baseline: 0.97x Medicare

The contracted insurance negotiated median rate for a Prosthetic fitting and training at Ascension Seton Hays is $39. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $55. Compared to the federal Medicare reimbursement reference rate of $40.41, this hospital’s rate is 0.97x the Medicare baseline. Located in 6001 Kyle Pkwy, Kyle, TX.

Cash / Self-Pay

$55

Average discount available for prompt cash payment at this facility.

Insurance Median

$39

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: $55 (136%)

Insurance Median: $39 (97%)

Cash: $55 (136% of Medicare)

Ins. Median: $39 (97% 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
Tricare	$34 - $39	84%
Aarp Mc Wellmed	$38	94%
Addr Cancer Together	$39	97%
Aetna	$39	97%
Covid Hrsa	$39	97%
Cshcn Cidc	$39	97%
Devoted Health Mcr Replacement	$39	97%
Humana	$39	97%
Medicare (plans)	$39	97%
Research Study	$39	97%
Sendero Chap	$39	97%
Smarthealth	$39	97%
Superior Allwell	$39	97%
Utmb	$39	97%
Wellcare Med Advantage	$39	97%
Champva	$40 - $42	99%
Connected Senior Care	$40	99%
UnitedHealthcare	$40	99%
Pphp Mcr Advantage	$41	101%
Tx Independence Hp	$41	101%
Occunet	$55	136%
Sendero Idealcare	$68	168%
Ambetter / Centene	$70	173%
Blue Cross Blue Shield	$72 - $174	178%

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 $55.
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 Ascension Seton Hays 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.