CMS Price Transparency Data

Prosthetic fitting and training

Facility: University of Wi Hospitals & Clinics Authority

Billing Code: 97761 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97761
Insurance Median: $106
Cash Discount Price: $100
vs. Medicare Baseline: 2.62x Medicare

The contracted insurance negotiated median rate for a Prosthetic fitting and training at University of Wi Hospitals & Clinics Authority is $106. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $100. Compared to the federal Medicare reimbursement reference rate of $40.41, this hospital’s rate is 2.62x the Medicare baseline. Located in 600 Highland Avenue, Madison, WI.

Cash / Self-Pay

$100

Average discount available for prompt cash payment at this facility.

Insurance Median

$106

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: $100 (247%)

Insurance Median: $106 (262%)

Cash: $100 (247% of Medicare)

Ins. Median: $106 (262% 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 262% of the Medicare baseline (a markup of 162%). 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
Medicare (plans)	$50 - $116	124%
Alliance_Premier_Network	$79	195%
Mercycare	$82	203%
Triology	$85 - $101	210%
Security_Health_Plan	$90 - $105	223%
Employer'S_Coalition_On_Health	$91 - $128	225%
Alliance	$93	230%
Hfn	$95 - $128	235%
United_Healthcare	$95 - $141	235%
Beloit_Health_System	$96	238%
Aspirus_Health_Plan	$97	240%
Cigna	$100	247%
Health_Partners_Insurance	$101	250%
Health_Payment_Systems	$102	252%
UnitedHealthcare	$104	257%
Dean_Health_Plan	$106	262%
Medical_Associates	$110	272%
Wps	$115 - $127	285%
Employers_Healthcare_Coalition_Of_Wi	$116	287%
Aetna	$118 - $133	292%
Blue Cross Blue Shield	$119 - $350	294%
Aspirus_Network_Inc	$128	317%
Chorus_Community	$133	329%
Ghc_Eau_Claire_Health_Plan	$133	329%
Multiplan	$133 - $153	329%
Sheybogan_Employers_Health_Network	$133	329%
Coventry	$141	349%
Dean_Care	$141	349%
Healthsmart	$146	361%

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 $100.
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 University of Wi Hospitals & Clinics Authority 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.