Prosthetic fitting and training
Facility: Hamilton County Hospital
Billing Code: 97761 (CPT)
- CPT Billing Code: 97761
- Insurance Median: $90
- Cash Discount Price: $100
- vs. Medicare Baseline: 2.23x 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 223% of the Medicare baseline (a markup of 123%). 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 | $24 - $50 | 59% |
| First Health Coventry - All Plans | $85 | 210% |
| UnitedHealthcare | $95 | 235% |
| Cigna | $95 | 235% |
| Va Ccn - All Plans | $100 | 247% |
| Aetna | $170 | 421% |
Consumer Guidance & Cost Commentary
For the CPT code 97761, "Prosthetic fitting and training," Hamilton County Hospital in Syracuse, KS, lists a cash price of $100.00, which matches the facility's gross chargemaster rate. This cash price is notably lower than the state average, as the median negotiated rate for this service in Kansas is $90.00. While commercial payers like Aetna and UnitedHealthcare have negotiated rates of $170.00 and $95.00 respectively, the cash price of $100.00 represents a significant discount compared to these insurance amounts. Patients with high-deductible plans or those who have exhausted their out-of-pocket maximums may find that paying the cash price directly is more cost-effective than relying on insurance, which could result in balance billing if the provider is out-of-network or if ancillary services are not covered under the plan.
To ensure you are receiving the best possible rate, it is recommended to contact the hospital directly to inquire about "self-pay" or "prompt-pay" discounts, which can further reduce the final bill. If you choose to use insurance, be aware that the facility's negotiated rate of $90.00 is below the state median of $90.00, but you should verify your specific plan's allowed amount before scheduling to avoid unexpected costs. Furthermore, if you receive a summary bill, request a full itemized audit to identify any errors, double-billing, or unbundled codes, as over 80% of hospital bills contain inaccuracies. If you encounter a surprise balance bill from an out-of-network provider at this in-network facility, you