CMS Price Transparency Data

Prosthetic fitting and training

Facility: Forks Community Hospital

Billing Code: 97761 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97761
Insurance Median: $83
Cash Discount Price: $127
vs. Medicare Baseline: 2.05x Medicare

The contracted insurance negotiated median rate for a Prosthetic fitting and training at Forks Community Hospital is $83. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $127. Compared to the federal Medicare reimbursement reference rate of $40.41, this hospital’s rate is 2.05x the Medicare baseline. Located in 530 Bogachiel Way, Forks, WA.

Cash / Self-Pay

$127

Average discount available for prompt cash payment at this facility.

Insurance Median

$83

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: $127 (314%)

Insurance Median: $83 (205%)

Cash: $127 (314% of Medicare)

Ins. Median: $83 (205% 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 205% of the Medicare baseline (a markup of 105%). 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
Medicaid / KanCare	$55 - $58	136%
Coordinated Care (Mco) Mcd-All Plans	$59	146%
UnitedHealthcare	$71 - $135	176%
Community Health Network Mcr-All Other Plans	$72	178%
Humana	$72	178%
Tricare	$72	178%
Triwest-All Plans	$72	178%
Ambetter / Centene	$83	205%
Wellcare Med Adv - All Plans	$83	205%
Regence-All Other Plans	$92	228%
Community Health Exchange	$103	255%
Molina Commercial-All Other Plans	$146	361%
Aetna	$151	374%
Blue Cross Blue Shield	$151	374%
Cigna	$159	393%
First Choice-All Plans	$159	393%
Medicare (plans)	$318	787%

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 $127.
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 Forks 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.