Prosthetic fitting and training
Facility: Mercy Specialty Hospital Southeast Kansas
Billing Code: 97761 (CPT)
- CPT Billing Code: 97761
- Insurance Median: $72
- Cash Discount Price: $90
- vs. Medicare Baseline: 1.78x 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 |
|---|---|---|
| Medicaid / KanCare | $20 - $37 | 49% |
| Blue Cross Blue Shield | $20 - $38 | 49% |
| UnitedHealthcare | $35 - $129 | 87% |
| Aetna | $35 - $70 | 87% |
| Humana | $36 - $38 | 89% |
| Cigna | $37 - $107 | 92% |
| Cross Timbers Hospice [20098] | $37 | 92% |
| Mercy Mgd Behavioral Health Contracted [320259] | $37 | 92% |
| Kindful Hospice Contracted [320434] | $37 | 92% |
| Medicare (plans) | $37 | 92% |
| Centivo Contracted [320505] | $37 | 92% |
| Tricare | $37 | 92% |
| Cherokee Nation Health Serv Contracted [320066] | $37 | 92% |
| Halo Hcr Inc Hospice Contracted [320432] | $37 | 92% |
| Mercy Hospice Okc [20252] | $37 | 92% |
| Medical Associates Health Contracted [320444] | $37 | 92% |
| Qual Choice Contracted [320325] | $37 | 92% |
| Kindful Hospice [20434] | $37 | 92% |
| Elara Caring Aspire Hospice [20433] | $37 | 92% |
| Globalhealth Contracted [320145] | $37 | 92% |
| Pace Of The Ozarks Contracted [320518] | $37 | 92% |
| Halo Hcr Inc Hospice [20432] | $37 | 92% |
| Dept Of Veteran Affairs Contracted [320106] | $38 | 94% |
| Provider Partners Health Plans Contracted [320450] | $40 | 99% |
| Medica Contracted [320239] | $51 | 126% |
| First Health Contracted [320128] | $70 | 173% |
| Point C Contracted [320238] | $70 - $104 | 173% |
| Providrs Care Network Contracted [320484] | $72 | 178% |
| Mercy Benefit Admin Contracted [320251] | $83 - $97 | 205% |
| Show-Me Health Administrators Contracted [320483] | $83 | 205% |
| Yuzu Health Contracted [320521] | $97 | 240% |
| Ebms Contracted [320493] | $97 | 240% |
| Edison Health Solutions Contracted [320502] | $97 | 240% |
| Aither Health Contracted [320449] | $97 | 240% |
| American Healthcare Alliance Contracted [320020] | $97 | 240% |
| Reflect Health Contracted [320492] | $97 | 240% |
| Auxiant Contracted [320462] | $97 - $104 | 240% |
| Imagine 360 Contracted [320494] | $97 | 240% |
| United Medical Resources Contracted [320454] | $102 - $104 | 252% |
| Insurance System Inc Contracted [320465] | $104 | 257% |
| Federal Medical Center Contracted [320127] | $104 | 257% |
| Healthlink Contracted [320179] | $104 | 257% |
| Health Systems Inc Contracted [320174] | $104 | 257% |
| Healthscope Contracted [320182] | $104 | 257% |
| Preferred Health Plan Contracted [320522] | $104 | 257% |
| Benefit Management Contracted [320052] | $104 | 257% |
| Compcare Of The Ozarks Contracted [320437] | $110 | 272% |
| Workers Comp [20426] | $111 | 275% |
| Private Health Care Systems Contracted [320320] | $129 | 319% |
| Multiplan [20270] | $132 | 327% |
| Multiplan Contracted [320270] | $132 | 327% |
Consumer Guidance & Cost Commentary
For the CPT code 97761, "Prosthetic fitting and training," Mercy Specialty Hospital Southeast Kansas lists a gross charge of $139.00. While the facility offers a cash median price of $90.00, commercial insurance negotiated rates vary significantly, ranging from $20 to $132 across 51 different payers. Notably, several major insurers, including UnitedHealthcare and Point C, have negotiated rates exceeding the cash price, which can result in higher out-of-pocket costs for patients with high-deductible plans. Because commercial rates often include administrative overhead and contract markups, patients should verify their specific plan's allowed amount before scheduling. It is also advisable to ask the hospital directly about "self-pay" or "prompt-pay" discounts, which can reduce the final bill by 20% to 50% if paid in full upfront.
The facility's cash rate of $90.00 is notably lower than the highest negotiated rates found in the data, such as the $132 charge from Multiplan, but it remains above the Medicare benchmark of $40.41. Under Medicare benchmarking principles, commercial rates are often marked up significantly above the federal baseline, which represents the true cost of care. If a patient receives out-of-network care, they may face balance billing for the difference between the provider's full charge and the insurance allowed amount, though the No Surprises Act protects against this for emergency services at in-network facilities. To avoid unexpected costs, patients should request an itemized billing audit to ensure no unbundled codes or services not rendered are included, and they should dispute any surprise bills in writing rather than