Prosthetic fitting and training
Facility: Stormont Vail Hospital
Billing Code: 97761 (CPT)
- CPT Billing Code: 97761
- Insurance Median: $21
- Cash Discount Price: Unavailable
- vs. Medicare Baseline: 0.52x 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 |
|---|---|---|
| Ambetter / Centene | $21 | 52% |
| Blue Cross Blue Shield | $21 - $78 | 52% |
| UnitedHealthcare | $21 | 52% |
Consumer Guidance & Cost Commentary
For the CPT code 97761, "Prosthetic fitting and training," Stormont Vail Hospital in Topeka, KS, has a median negotiated payment of $12,954.00, which is significantly higher than the Medicare benchmark of $40.41. This indicates a substantial markup relative to the federal government's cost-based reimbursement standard. While the facility offers a median negotiated rate of $21.00 across three payers including Blue Cross Blue Shield and UnitedHealthcare, these commercial rates remain far above the Medicare baseline. Patients should be aware that while in-network insurance provides a ceiling on charges, the actual amount paid can vary widely depending on the specific plan and deductible status, often resulting in costs that exceed the facility's cash price.
Given that cash-pay rates are not explicitly listed in the data, patients with high-deductible plans or those seeking immediate cost certainty should inquire directly about self-pay or prompt-pay discounts before scheduling services. Hospitals often offer significant fee reductions for upfront payments to bypass administrative billing cycles, which can result in a lower total cost than the standard negotiated rate. It is crucial to request a full itemized bill containing specific CPT codes before finalizing payment, as summary bills may obscure individual charges or unbundled services. Additionally, verifying the facility's status as a voluntary non-profit acute care hospital in the 66604 zip code can help patients understand the organizational structure, though specific county or state average comparisons for this procedure were not provided in the available data.