Prosthetic fitting and training
Facility: St. Catherine Hospital - Garden City
Billing Code: 97761 (CPT)
- CPT Billing Code: 97761
- Insurance Median: $78
- Cash Discount Price: $63
- vs. Medicare Baseline: 1.93x 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 |
|---|---|---|
| Denver Health | $29 - $58 | 72% |
| Direct To Employer | $33 - $107 | 82% |
| Kaiser | $34 - $70 | 84% |
| UnitedHealthcare | $41 - $232 | 101% |
| Aetna | $42 - $161 | 104% |
| Kansas Health | $42 | 104% |
| Humana | $42 | 104% |
| Innovage | $42 | 104% |
| Devoted Health | $42 | 104% |
| Medicare (plans) | $42 | 104% |
| Blue Cross Blue Shield | $42 - $205 | 104% |
| Cigna | $42 - $202 | 104% |
| Peak Health | $47 - $99 | 116% |
| Wpaa | $56 - $134 | 139% |
| Christian Health Aid | $65 - $153 | 161% |
| Centura Employee Plan | $72 | 178% |
| Multiplan | $73 - $210 | 181% |
| Health Partners Of Kansas | $78 - $185 | 193% |
| United Colorado Doctor'S Plan | $143 - $150 | 354% |
Consumer Guidance & Cost Commentary
For the CPT code 97761, Prosthetic fitting and training, St. Catherine Hospital - Garden City lists a gross charge of $156.00, which is significantly higher than the facility's own cash median of $63.00. While the hospital is a Voluntary non-profit - Church located in Garden City, KS (ZIP 67846), the negotiated rates vary widely depending on the payer, ranging from $29 for Denver Health plans to $232 for UnitedHealthcare. It is important to note that Kaiser's listed rate of $34 to $70 is an integrated-system internal rate and not a typical negotiated rate. For patients with high-deductible plans, paying the cash price of $63.00 upfront may be more cost-effective than relying on insurance, as many commercial negotiated rates exceed this amount. Additionally, patients should inquire about prompt-pay discounts, which can reduce the final bill by 20% to 50% if paid in full within 30 days, effectively bypassing the administrative costs associated with insurance claims processing.
When evaluating the cost of this service, it is crucial to compare rates against the Medicare benchmark rather than the hospital's gross chargemaster. The Medicare amount for this procedure is $40.41, and the facility's negotiated rate is 1.9 times the Medicare amount, indicating a markup that is substantially higher than the fair pricing range of 120% to 150% of Medicare. Although the facility has received a rating of 2, the data shows that some payers, such as Multiplan and Blue Cross Blue Shield, have negotiated rates reaching