Prosthetic fitting and training
Facility: Kansas City Orthopaedic Institute
Billing Code: 97761 (CPT)
- CPT Billing Code: 97761
- Insurance Median: $138
- Cash Discount Price: Unavailable
- vs. Medicare Baseline: 3.41x 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 341% of the Medicare baseline (a markup of 241%). 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 |
|---|---|---|
| Cigna | $52 | 129% |
| Aetna | $53 | 131% |
| UnitedHealthcare | $53 | 131% |
| Blue Cross Blue Shield | $138 | 341% |
Consumer Guidance & Cost Commentary
For the CPT code 97761, "Prosthetic fitting and training," at the Kansas City Orthopaedic Institute in Leawood, KS, the facility's negotiated rates range from $52 to $138 depending on the insurance carrier. While the median negotiated rate is $138, this is significantly higher than the Medicare benchmark of $40.41, reflecting the standard administrative markup inherent in commercial contracts. It is important to note that cash-pay rates are not listed for this service, meaning patients with high-deductible plans may find the insurance negotiated rate more affordable than paying out-of-pocket, as the cash price is unavailable for comparison.
Patients should be aware that while the No Surprises Act protects against balance billing for out-of-network providers at in-network facilities, it does not apply to self-pay scenarios. Since the facility is a physician-owned acute care hospital, individuals without insurance or with self-pay status should explicitly ask about "self-pay" or "prompt-pay" discounts before scheduling, as these upfront payment incentives can reduce costs by 20% to 50%. Additionally, if a bill is received, consumers should request a full itemized audit rather than accepting a summary invoice, as over 80% of hospital bills contain errors such as unbundled codes or services not rendered that can be disputed to lower the final amount owed.