Prosthetic fitting and training
Facility: Mercy Hospital Pittsburg, Inc
Billing Code: 97761 (CPT)
- CPT Billing Code: 97761
- Insurance Median: $38
- Cash Discount Price: $54
- vs. Medicare Baseline: 0.94x Medicare
Average discount available for prompt cash payment at this facility.
Median negotiated contract rate across all mapped commercial carriers.
Standard federal government reimbursement rate for this code.
Visual Cost Comparison vs. 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.
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 | $20 - $61 | 49% |
| Medicaid / KanCare | $20 - $38 | 49% |
| Medica Contracted [320239] | $30 | 74% |
| UnitedHealthcare | $35 - $56 | 87% |
| Aetna | $36 - $71 | 89% |
| Tricare | $36 | 89% |
| Humana | $36 - $37 | 89% |
| Pace Of The Ozarks Contracted [320518] | $37 | 92% |
| Dept Of Veteran Affairs Contracted [320106] | $37 | 92% |
| Halo Hcr Inc Hospice Contracted [320432] | $37 | 92% |
| Halo Hcr Inc Hospice [20432] | $37 | 92% |
| Medicare (plans) | $37 | 92% |
| Cross Timbers Hospice [20098] | $37 | 92% |
| Kindful Hospice [20434] | $37 | 92% |
| Kindful Hospice Contracted [320434] | $37 | 92% |
| Mercy Hospice Okc [20252] | $37 | 92% |
| Elara Caring Aspire Hospice [20433] | $37 | 92% |
| Ambetter / Centene | $38 | 94% |
| Home State Health Plan Contracted [320187] | $38 | 94% |
| American Health Advantage Of Ks Mcr Contracted [320508] | $39 | 97% |
| United Medical Resources Contracted [320454] | $56 | 139% |
| Cigna | $57 - $64 | 141% |
| Health Choice Contracted [320166] | $63 | 156% |
| Imagine 360 Contracted [320494] | $66 | 163% |
| American Healthcare Alliance Contracted [320020] | $66 | 163% |
| Ebms Contracted [320493] | $66 | 163% |
| Yuzu Health Contracted [320521] | $66 | 163% |
| Healthlink Contracted [320179] | $66 | 163% |
| Mercy Benefit Admin Contracted [320251] | $66 | 163% |
| Aither Health Contracted [320449] | $66 | 163% |
| Workers Comp [20426] | $66 | 163% |
| Auxiant Contracted [320462] | $66 | 163% |
| Reflect Health Contracted [320492] | $66 | 163% |
| Edison Health Solutions Contracted [320502] | $66 | 163% |
| First Health Contracted [320128] | $71 | 176% |
| Providrs Care Network Contracted [320484] | $72 | 178% |
Consumer Guidance & Cost Commentary
For the CPT code 97761, representing prosthetic fitting and training, the gross charge at Mercy Hospital Pittsburg, Inc. is $83.00. While the facility offers a cash median price of $54.00, which is lower than the gross charge, patients should be aware that commercial insurance negotiated rates often exceed this cash price due to administrative costs and contract structures. For instance, UnitedHealthcare and Aetna have negotiated ranges starting at $35.00 and $36.00 respectively, while many other payers, including Medicare and various hospice contractors, have a fixed allowed amount of $37.00. In cases where a patient's insurance negotiated rate is higher than the cash price, paying out-of-pocket could result in significant savings, particularly for those with high-deductible plans. It is advisable to contact the hospital directly to inquire about "self-pay" or "prompt-pay" discounts, which can further reduce the final amount owed.
The facility's pricing should be evaluated against the Medicare benchmark, which serves as the most reliable indicator of the true cost of care. The Medicare allowed amount for this service is $40.41, and the facility's cash rate of $54.00 represents a markup of approximately 33% over this federal baseline. While commercial negotiated rates vary widely across the 36 identified payers, ranging from $20.00 for some Medicaid plans to $72.00 for Providrs Care Network, the data highlights that the gross charge of $83.00 is significantly inflated compared to both the Medicare rate and the median negotiated rate of $38.