Prosthetic fitting and training
Facility: Ascension Via Christi Hospital Manhattan, Inc
Billing Code: 97761 (CPT)
- CPT Billing Code: 97761
- Insurance Median: $38
- Cash Discount Price: $62
- 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 - $106 | 49% |
| Aetna | $21 | 52% |
| Medicaid / KanCare | $21 - $26 | 52% |
| Va | $38 | 94% |
| Medicare (plans) | $38 - $39 | 94% |
| Humana | $38 | 94% |
| Providrs Care | $50 | 124% |
| Smarthealth | $53 | 131% |
| Blue Cross Blue Shield | $55 - $58 | 136% |
| Ambetter / Centene | $65 | 161% |
Consumer Guidance & Cost Commentary
For this procedure, the facility's cash price of $62.00 is significantly lower than the negotiated rates charged by most major payers, which range from $20 to $65 depending on the specific insurance plan. While the facility's cash rate is higher than the state average of $38.00, it remains well below the gross chargemaster price of $155.00. Patients with high-deductible plans or those without insurance may find the cash price more affordable than their insurance allowed amounts, as many commercial payers negotiate rates that exceed the cash-pay option. It is important to note that while the facility offers a cash rate, patients should verify if "self-pay" or "prompt-pay" discounts are available before scheduling to potentially lower the final cost further.
The facility's pricing is benchmarked against Medicare, which sets a baseline rate of $40.41 for this service. The facility's cash price of $62.00 represents a 52% markup over the Medicare rate, which is consistent with the typical range of 120% to 150% considered fair for commercial pricing. If a patient chooses to use insurance, they should be aware that while the No Surprises Act protects against balance billing for emergency care and non-emergency services at in-network facilities, unexpected charges can still occur for out-of-network ancillary services like certain lab tests or physician visits. To avoid these surprises, patients should request an itemized bill before payment and dispute any charges that do not align with the detailed CPT codes provided, as over 80% of hospital bills contain errors that can be corrected through a formal audit.