Prosthetic fitting and training
Facility: Saint Luke'S South Hospital
Billing Code: 97761 (CPT)
- CPT Billing Code: 97761
- Insurance Median: $88
- Cash Discount Price: $110
- vs. Medicare Baseline: 2.18x 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 218% of the Medicare baseline (a markup of 118%). 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 |
|---|---|---|
| Medicaid / KanCare | $20 - $53 | 49% |
| UnitedHealthcare | $24 - $127 | 59% |
| Aetna | $26 - $175 | 64% |
| Transplants-Case Rates [5750] | $36 - $184 | 89% |
| Blue Cross Blue Shield | $41 - $88 | 101% |
| Cigna | $50 - $289 | 124% |
| Humana | $59 - $73 | 146% |
| First Health [5512] | $109 | 270% |
| Commercial-Contracted [8000] | $138 - $203 | 341% |
Consumer Guidance & Cost Commentary
For the CPT code 97761, Prosthetic fitting and training, Saint Luke's South Hospital in Overland Park, KS, lists a cash price of $184.00. This cash rate is significantly higher than the facility's own negotiated average of $88.00 and exceeds the state average, which is reflected in the 2.2x multiplier compared to the Medicare benchmark of $40.41. While commercial payers like Medicaid/KanCare and UnitedHealthcare have negotiated rates ranging from $20 to $127, these amounts often exceed the cash price, meaning patients with high-deductible plans might save money by paying the cash rate directly. It is important to note that cash payments can sometimes be cheaper than insurance reimbursement if the negotiated rate exceeds the cash price, so patients should verify their specific plan's allowed amount before scheduling.
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, unexpected charges can still occur if ancillary services are billed separately. To avoid confusion, consumers should request a full itemized bill before paying, as summary bills may obscure individual code costs or unbundled charges. Additionally, many hospitals offer prompt-pay discounts for upfront payments, which can reduce the final bill by 20% to 50%. We recommend contacting Saint Luke's South Hospital directly to confirm their self-pay or prompt-pay rates and to ensure no unnecessary insurance claims are submitted that could void a potential cash discount.