Prosthetic fitting and training
Facility: Lmh
Billing Code: 97761 (CPT)
- CPT Billing Code: 97761
- Insurance Median: $43
- Cash Discount Price: $42
- vs. Medicare Baseline: 1.06x 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 - $108 | 49% |
| UnitedHealthcare | $20 - $166 | 49% |
| Allwell | $34 - $39 | 84% |
| Haskell Indian Health Services | $38 | 94% |
| Medicare (plans) | $38 | 94% |
| Cigna | $38 - $111 | 94% |
| Humana | $38 | 94% |
| Ambetter / Centene | $50 - $59 | 124% |
| Aetna | $106 - $138 | 262% |
| Non Contracted | $133 | 329% |
| First Health | $155 | 384% |
Consumer Guidance & Cost Commentary
For the CPT code 97761, Prosthetic fitting and training, the facility in Lawrence, KS, lists a cash price of $42.00, which is notably lower than the state average of $43.00. While the facility's negotiated rates with major payers like Blue Cross Blue Shield and UnitedHealthcare range from $20 to $166, patients with high-deductible plans may find the cash price more advantageous if their insurance allowed amount exceeds $42.00. It is important to note that commercial negotiated rates often include administrative overhead and can be significantly higher than the cash price, so verifying your specific plan's allowed amount before scheduling is essential to avoid unexpected costs.
Patients should be aware that while the No Surprises Act protects against balance billing for emergency care and non-emergency services from out-of-network providers at in-network facilities, it does not automatically eliminate all potential charges. If you receive a bill that seems to include charges for services not rendered or unbundled components, you have the right to request a formal itemized billing audit to identify errors. Additionally, if you choose to pay out-of-pocket, you should explicitly ask the hospital about "self-pay" or "prompt-pay" discounts before check-in, as paying upfront can sometimes reduce the final amount owed compared to the standard cash price listed.