CMS Price Transparency Data

Prosthetic fitting and training

Facility: Charleston Area Medical Center

Billing Code: 97761 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97761
Insurance Median: $136
Cash Discount Price: $339
vs. Medicare Baseline: 3.37x Medicare

The contracted insurance negotiated median rate for a Prosthetic fitting and training at Charleston Area Medical Center is $136. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $339. Compared to the federal Medicare reimbursement reference rate of $40.41, this hospital’s rate is 3.37x the Medicare baseline. Located in 501 Morris Street, Charleston, WV.

Cash / Self-Pay

$339

Average discount available for prompt cash payment at this facility.

Insurance Median

$136

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: $339 (839%)

Insurance Median: $136 (337%)

Cash: $339 (839% of Medicare)

Ins. Median: $136 (337% 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 337% of the Medicare baseline (a markup of 237%). 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
Aetna	$30 - $332	74%
The Health Plan Of West Virginia Inc.	$30 - $329	74%
Unicare Health Plan Of West Virginia Inc.	$30	74%
Triwest Va	$36	89%
Blue Cross Blue Shield	$38 - $309	94%
Choicecare Network	$38 - $332	94%
UnitedHealthcare	$39 - $332	97%
West Virginia Senior Advantage Inc.	$39	97%
Integrated Medical Solutions	$73	181%
Naphcare	$75	186%
Caresource	$94	233%
Optimum Choice Inc.	$136	337%
Tricare	$203	502%
City Of Charleston	$254	629%
Cigna	$315	780%
Three Rivers Providers Network	$329	814%
Healthsmart	$332	822%
Multiplan	$332	822%

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 $339.
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 Charleston Area Medical Center 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.