Prosthetic fitting and training
Facility: Centura St. Catherine-Dodge City
Billing Code: 97761 (CPT)
- CPT Billing Code: 97761
- Insurance Median: $126
- Cash Discount Price: $76
- vs. Medicare Baseline: 3.12x 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 312% of the Medicare baseline (a markup of 212%). 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 |
|---|---|---|
| Blue Cross Blue Shield | $42 - $59 | 104% |
| Humana | $42 | 104% |
| Kansas Health | $42 | 104% |
| Cigna | $42 | 104% |
| Kaiser | $42 | 104% |
| Medicare (plans) | $42 | 104% |
| Aetna | $42 - $153 | 104% |
| Centura Employee Plan | $72 | 178% |
| UnitedHealthcare | $126 | 312% |
| Wpaa | $134 | 332% |
| Christian Health Aid | $153 | 379% |
| Multiplan | $153 - $172 | 379% |
| Health Partners Of Kansas | $172 | 426% |
Consumer Guidance & Cost Commentary
For the CPT code 97761, "Prosthetic fitting and training," the facility's cash median rate is $76.00, which is significantly lower than the state average of $126.00. While Medicare sets a benchmark of $40.41 for this service, commercial negotiated rates vary widely, ranging from $42 to $172 depending on the insurance plan. For patients with high-deductible plans, paying the cash price of $76.00 upfront may be more cost-effective than relying on insurance, as many commercial rates exceed the cash amount. It is advisable to contact the hospital directly to confirm if "self-pay" or "prompt-pay" discounts are available, as these can further reduce the final cost before any insurance claim is processed.
When evaluating the financial impact of insurance, it is important to understand that negotiated rates often include administrative overhead and do not always reflect the true cost of care. In this case, while some payers like Blue Cross Blue Shield and Humana have a low negotiated range of $42, others such as Multiplan and Christian Health Aid have rates as high as $172. Patients should verify their specific plan's allowed amount before scheduling, as assuming that being in-network guarantees the lowest price can lead to unexpected costs if the deductible has not been met. Additionally, if you receive a bill from an out-of-network provider at this facility, the No Surprises Act may protect you from balance billing for non-emergency services, so you should review your itemized statement carefully to ensure all charges are accurate and compliant with federal regulations.