Prosthetic fitting and training
Facility: Rawlins County Health Center
Billing Code: 97761 (CPT)
- CPT Billing Code: 97761
- Insurance Median: $87
- Cash Discount Price: $85
- vs. Medicare Baseline: 2.15x 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 215% of the Medicare baseline (a markup of 115%). 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 | $50 | 124% |
| UnitedHealthcare | $87 | 215% |
Consumer Guidance & Cost Commentary
For the procedure "Prosthetic fitting and training" at Rawlins County Health Center in Atwood, Kansas, the cash median price is $85.00, which is lower than the facility's negotiated rates of $87.00 and the state average of $87.00. While the facility is a Critical Access Hospital with a voluntary non-profit ownership structure, patients should be aware that commercial payers like Blue Cross Blue Shield and UnitedHealthcare have negotiated rates of $50.00 and $87.00 respectively, which differ significantly from the cash price. In cases where a patient has a high-deductible plan, paying the cash price of $85.00 upfront may be more cost-effective than relying on insurance, as the negotiated rates can sometimes exceed the cash amount. It is important to verify the specific status of your plan and ask the hospital directly about "self-pay" or "prompt-pay" discounts before scheduling, as these incentives can further reduce the final cost.
Regarding billing transparency, patients should avoid accepting summary bills that only show broad categories like "Laboratory" or "Pharmacy," as these often obscure individual code costs and potential errors. Since over 80% of hospital bills contain mistakes such as double-billing or unbundled services, requesting a detailed, line-by-line itemized statement is the most effective way to identify charges for services not rendered or components that should have been bundled. Additionally, while the No Surprises Act protects patients from balance billing for emergency care and non-emergency services from out-of-network providers at in-network facilities, patients should still be cautious of consent waivers signed during registration that may inadvertently waive these protections. If a