CMS Price Transparency Data

Prosthetic fitting and training

Facility: Lonesome Pine Hospital

Billing Code: 97761 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97761
Insurance Median: $42
Cash Discount Price: $32
vs. Medicare Baseline: 1.04x Medicare

The contracted insurance negotiated median rate for a Prosthetic fitting and training at Lonesome Pine Hospital is $42. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $32. Compared to the federal Medicare reimbursement reference rate of $40.41, this hospital’s rate is 1.04x the Medicare baseline. Located in 1990 Holton Avenue East, Big Stone Gap, VA.

Cash / Self-Pay

$32

Average discount available for prompt cash payment at this facility.

Insurance Median

$42

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: $32 (79%)

Insurance Median: $42 (104%)

Cash: $32 (79% of Medicare)

Ins. Median: $42 (104% 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
Amerigroup	$37 - $40	92%
Aetna	$40 - $91	99%
Blue Cross Blue Shield	$40 - $213	99%
Humana	$40	99%
Managed Medicaire	$40	99%
Medicare (plans)	$40	99%
Sentara Health	$40 - $54	99%
United Mine Workers Of America	$40	99%
UnitedHealthcare	$40 - $213	99%
Cigna	$42 - $99	104%
Devoted Health Plan	$42	104%
Molina Healthcare	$42 - $47	104%
Mountain Empire Pace	$42	104%
Nhc Advantage	$42	104%
Wellcare	$42	104%
Optima Health	$46	114%
Ambetter / Centene	$87	215%
Seven Corners, Inc.	$96	238%
Medcost	$101	250%
First Health Coventry	$192	475%

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 $32.
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 Lonesome Pine 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.