CMS Price Transparency Data

Prosthetic fitting and training

Facility: Holy Family Memorial

Billing Code: 97761 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97761
Insurance Median: $82
Cash Discount Price: $63
vs. Medicare Baseline: 2.03x Medicare

The contracted insurance negotiated median rate for a Prosthetic fitting and training at Holy Family Memorial is $82. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $63. Compared to the federal Medicare reimbursement reference rate of $40.41, this hospital’s rate is 2.03x the Medicare baseline. Located in 2300 Western Ave, Manitowoc, WI.

Cash / Self-Pay

$63

Average discount available for prompt cash payment at this facility.

Insurance Median

$82

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: $63 (156%)

Insurance Median: $82 (203%)

Cash: $63 (156% of Medicare)

Ins. Median: $82 (203% 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 203% of the Medicare baseline (a markup of 103%). 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
Medical College Of Wisconsin	$38	94%
Blue Cross Blue Shield	$39 - $248	97%
Community Care Incorporated	$39	97%
Health Partners	$39 - $74	97%
Humana	$39	97%
Icare	$39	97%
Molina	$39 - $42	97%
Network Health Plan	$39 - $263	97%
Security Health Plan	$39 - $91	97%
UnitedHealthcare	$39 - $370	97%
Allwell	$40	99%
Centivo	$46 - $52	114%
Dean Health Plan	$57	141%
Health Payment Systems	$64	158%
Sheboygan Employers Health Network	$68	168%
Chorus Community Health Plan	$73	181%
Trilogy	$75	186%
Cigna	$82	203%
Wps Health Plan	$84	208%
Aspirus	$91	225%
Healtheos	$91	225%
Multiplan/Private Healthcare Systems	$91	225%
Preferred One	$91	225%
Healthsmart	$95	235%
First Health Network	$100	247%

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 $63.
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 Holy Family Memorial 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.