Prosthetic fitting and training
Facility: Graham County Hospital
Billing Code: 97761 (CPT)
- CPT Billing Code: 97761
- Insurance Median: $58
- Cash Discount Price: $75
- vs. Medicare Baseline: 1.44x 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 | $32 | 79% |
| UnitedHealthcare | $32 - $71 | 79% |
| Blue Cross Blue Shield | $50 | 124% |
| Medicare (plans) | $56 | 139% |
| Celtic Commercial-All Other Plans | $62 | 153% |
| Wppa (Providers Care)-All Plans | $71 | 176% |
Consumer Guidance & Cost Commentary
For the CPT code 97761, "Prosthetic fitting and training," Graham County Hospital in Hill City, KS, lists a cash price of $75.00, which matches the facility's cash median. This cash rate is notably higher than the state average for this service, where the median paid amount is $62.00. While commercial payers like UnitedHealthcare and Blue Cross Blue Shield have negotiated rates ranging from $32 to $71, patients with high-deductible plans should consider that paying cash upfront might be more cost-effective if the insurance negotiated rate exceeds the cash price. It is always advisable to contact the hospital directly to inquire about "self-pay" or "prompt-pay" discounts, which can further reduce the final bill.
The facility's Medicare allowed amount for this procedure is $40.41, which serves as a critical benchmark for evaluating pricing fairness. Commercial negotiated rates for this service generally range from 1.4 times the Medicare rate up to the full cash price, reflecting the administrative costs and contract dynamics inherent in insurance billing. Because over 80% of hospital bills contain errors, patients should request a detailed, itemized statement rather than accepting a summary bill, ensuring no charges for services not rendered or unbundled components are included. If a patient receives a balance bill from an out-of-network provider at this in-network facility, they may be entitled to protections under the No Surprises Act, which bans balance billing for emergency and non-emergency services.