Prosthetic fitting and training
Facility: Ellinwood District Hospital
Billing Code: 97761 (CPT)
- CPT Billing Code: 97761
- Insurance Median: $49
- Cash Discount Price: $60
- vs. Medicare Baseline: 1.21x 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 |
|---|---|---|
| Humana | $49 | 121% |
| Cigna | $49 | 121% |
| Aetna | $49 | 121% |
| Blue Cross Blue Shield | $49 | 121% |
| UnitedHealthcare | $49 | 121% |
Consumer Guidance & Cost Commentary
For the CPT code 97761, "Prosthetic fitting and training," Ellinwood District Hospital in Ellinwood, KS, lists a gross charge of $70.00. The facility's negotiated rates with major payers like Humana, Cigna, and Aetna are set at $49.00, which aligns with the median negotiated amount of $49.00 found across the state. This rate is 1.2 times the Medicare benchmark of $40.41, indicating the commercial price is higher than the federal baseline. While the cash median is $60.00, patients should note that paying cash upfront often avoids the administrative overhead associated with insurance claims, potentially resulting in a lower out-of-pocket cost if their deductible has not yet been met.
To minimize costs, patients should proactively ask the hospital about "self-pay" or "prompt-pay" discounts before scheduling, as these upfront payment incentives can reduce the final bill by 20% to 50%. It is also important to verify that the facility is in-network for your specific plan to avoid balance billing, which occurs when a provider bills you for the difference between their full charge and what your insurance pays. Since over 80% of hospital bills contain errors, you should request a detailed, itemized statement to review every charge line-by-line before agreeing to any payment plan or finalizing your balance.