CMS Price Transparency Data

Prosthetic fitting and training

Facility: Uva Health Culpeper Medical Center

Billing Code: 97761 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97761
Insurance Median: $89
Cash Discount Price: $95
vs. Medicare Baseline: 2.20x Medicare

The contracted insurance negotiated median rate for a Prosthetic fitting and training at Uva Health Culpeper Medical Center is $89. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $95. Compared to the federal Medicare reimbursement reference rate of $40.41, this hospital’s rate is 2.20x the Medicare baseline. Located in 501 Sunset Lane, Culpeper, VA.

Cash / Self-Pay

$95

Average discount available for prompt cash payment at this facility.

Insurance Median

$89

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: $95 (235%)

Insurance Median: $89 (220%)

Cash: $95 (235% of Medicare)

Ins. Median: $89 (220% 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 220% of the Medicare baseline (a markup of 120%). 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
Blue Ridge Pace [10510]	$36	89%
Medicaid / KanCare	$36	89%
Veterans [99909]	$38	94%
Aetna	$40 - $167	99%
Blue Cross Blue Shield	$40	99%
Cigna	$40 - $360	99%
HMO Part B [10099]	$40	99%
Humana	$40 - $41	99%
Medicare (plans)	$40	99%
UnitedHealthcare	$40 - $282	99%
VA Ccn [99926]	$40	99%
VA Ccn [99927]	$40	99%
Veterans Administration [99910]	$40	99%
Champva [50002]	$42	104%
Tricare	$42	104%
Carefirst [30007]	$81 - $86	200%
Sentara [40021]	$87 - $148	215%
Sentara Behavioral Health [40052]	$89 - $148	220%
Beacon Health Options [40012]	$95	235%
Commercial Contracted Hb Only [40056]	$100	247%
Commercial Generic [40000]	$100 - $133	247%
Geha [40009]	$110 - $228	272%
Commercial Contracted Tpa [40055]	$114 - $133	282%
Umwa [40037]	$133	329%
Healthsmart [40013]	$142	351%
Multiplan Generic [40035]	$144 - $162	356%
Vhn Generic [40040]	$144 - $162	356%
First Health Generic [40033]	$156	386%
Gateway Health Alliance [40034]	$162	401%
Onenet Workers Comp Generic [60010]	$166	411%
Kaiser Permenente [40014]	$171	423%

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 $95.
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 Uva Health Culpeper Medical Center 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.