CMS Price Transparency Data

Prosthetic fitting and training

Facility: Fort Memorial Hospital

Billing Code: 97761 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97761
Insurance Median: $159
Cash Discount Price: $73
vs. Medicare Baseline: 3.93x Medicare

The contracted insurance negotiated median rate for a Prosthetic fitting and training at Fort Memorial Hospital is $159. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $73. Compared to the federal Medicare reimbursement reference rate of $40.41, this hospital’s rate is 3.93x the Medicare baseline. Located in 611 Sherman Ave E, Fort Atkinson, WI.

Cash / Self-Pay

$73

Average discount available for prompt cash payment at this facility.

Insurance Median

$159

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: $73 (181%)

Insurance Median: $159 (393%)

Cash: $73 (181% of Medicare)

Ins. Median: $159 (393% 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 393% of the Medicare baseline (a markup of 293%). 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 Cross Blue Shield	$15 - $271	37%
Dean Health Plan	$15 - $150	37%
Medicaid / KanCare	$15	37%
Quartz	$15 - $216	37%
UnitedHealthcare	$15 - $173	37%
Managed Health Services	$16	40%
Humana	$41 - $163	101%
Molina	$42	104%
Veteran Evaluation Services	$66	163%
Aetna	$86 - $171	213%
Fort Care	$125	309%
Group Health Cooperative	$138 - $263	341%
Alliance	$153 - $164	379%
Mercycare	$159 - $170	393%
Trilogy	$188 - $201	465%
Cigna	$203 - $217	502%
Centivo	$288 - $300	713%

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 $73.
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 Fort Memorial 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.