Prosthetic fitting and training
Facility: Susan B Allen Memorial Hospital
Billing Code: 97761 (CPT)
- CPT Billing Code: 97761
- Insurance Median: $554
- Cash Discount Price: $129
- vs. Medicare Baseline: 13.71x 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.
Elevated Commercial Rate Alert (Value-Gap)
The negotiated rate at this facility is 1371% of the Medicare baseline (a markup of 1271%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.
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 | $350 | 866% |
| Providrs Care | $757 | 1873% |
Consumer Guidance & Cost Commentary
For the CPT code 97761, "Prosthetic fitting and training," Susan B Allen Memorial Hospital in El Dorado, KS, lists a cash median price of $129.00, which is significantly lower than the facility's gross charge of $199.00. While the hospital's negotiated rates with UnitedHealthcare and Providrs Care are $350.00 and $757.00 respectively, patients with high-deductible plans may find the cash price more advantageous if their insurance allowed amount exceeds this figure. It is important to note that the facility's negotiated rates are higher than the cash price, a common dynamic where administrative costs and contract structures inflate the insurance payment ceiling. Additionally, the facility's cash rate is notably lower than the state average for this procedure, offering a potential savings opportunity for those paying out-of-pocket.
When comparing this service to Medicare, the facility's cash price of $129.00 is 13.7% higher than the Medicare benchmark of $40.41. This markup reflects the complexity of the procedure and local cost factors, as Medicare rates serve as the objective baseline for evaluating hospital pricing. Patients should be aware that while the No Surprises Act protects against balance billing for out-of-network providers at in-network facilities, it does not apply to self-pay scenarios. To maximize savings, consumers should explicitly request "self-pay" or "prompt-pay" discounts before scheduling, as these upfront payment incentives can bypass the costly insurance billing cycle and reduce the final bill by 20% to 50%. Always verify your specific plan's deductible status and allowed amounts before assuming that an in-network rate