Prosthetic fitting and training
Facility: Saint John Hospital
Billing Code: 97761 (CPT)
- CPT Billing Code: 97761
- Insurance Median: $38
- Cash Discount Price: $38
- 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 |
|---|---|---|
| UnitedHealthcare | $20 - $53 | 49% |
| Medicaid / KanCare | $20 | 49% |
| Healthy Blue | $21 - $40 | 52% |
| Celtic | $21 - $130 | 52% |
| Blue Cross Blue Shield | $24 - $50 | 59% |
| Midland Care Connection | $38 | 94% |
| Cigna | $38 | 94% |
| Tricare | $38 | 94% |
| Medicare (plans) | $38 | 94% |
| Aetna | $38 | 94% |
| Kansas Superior Select | $39 | 97% |
| Well Path | $53 | 131% |
| Corizon | $53 | 131% |
| Employer Direct Healthcare | $53 | 131% |
| Centurion | $57 | 141% |
| Naphcare | $59 | 146% |
Consumer Guidance & Cost Commentary
For the CPT code 97761, "Prosthetic fitting and training," Saint John Hospital in Leavenworth, KS, lists a gross charge of $372.00. While the facility's cash median rate is $38.00, commercial insurance negotiated rates vary significantly across payers, ranging from a low of $20.00 to a high of $130.00. It is important to note that cash payments can sometimes be more cost-effective for patients with high-deductible plans if their insurance negotiated rate exceeds the cash price. Additionally, patients should verify if "self-pay" or "prompt-pay" discounts are available directly with the hospital before scheduling, as these upfront incentives can bypass administrative fees and reduce the final bill.
When evaluating the cost of this service, it is more accurate to compare rates against the Medicare benchmark rather than the facility's gross chargemaster. The Medicare amount for this code is $40.41, and the facility's cash rate of $38.00 is slightly lower, reflecting a relative value close to the federal baseline. Although the data does not provide specific state or county averages for this procedure, the facility's ownership as a voluntary non-profit and its location in an acute care setting suggest that commercial rates may include administrative markups. Consumers should request an itemized bill to ensure no unbundled charges or services not rendered are included, and if balance billing occurs, they may have protections under the No Surprises Act depending on the network status of the specific provider involved.