CMS Price Transparency Data

Prosthetic fitting and training

Facility: Gundersen Palmer Lutheran Hospital and Clinics

Billing Code: 97761 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97761
Insurance Median: $72
Cash Discount Price: $74
vs. Medicare Baseline: 1.78x Medicare

The contracted insurance negotiated median rate for a Prosthetic fitting and training at Gundersen Palmer Lutheran Hospital and Clinics is $72. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $74. Compared to the federal Medicare reimbursement reference rate of $40.41, this hospital’s rate is 1.78x the Medicare baseline. Located in 112 Jefferson Street, West Union, IA.

Cash / Self-Pay

$74

Average discount available for prompt cash payment at this facility.

Insurance Median

$72

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: $74 (183%)

Insurance Median: $72 (178%)

Cash: $74 (183% of Medicare)

Ins. Median: $72 (178% 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.

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
Amerigroup	$15 - $68	37%
Molina Health	$15	37%
UnitedHealthcare	$65 - $68	161%
Health Partners	$66 - $116	163%
Wellmark	$67 - $109	166%
Humana	$68	168%
Iowa Total Care	$68	168%
Managed Health Service	$68	168%
Ucare	$68 - $105	168%
Quartz	$71	176%
Alliance	$104 - $220	257%
Medical Associates	$105	260%
Aspirus Arise Health	$109	270%
Multiplan/Healtheos	$115 - $122	285%
Coventry Health Care	$124	307%
Midland Choice	$127	314%

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 $74.
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 Gundersen Palmer Lutheran Hospital and Clinics 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.