Prosthetic fitting and training
Facility: Ellsworth County Medical Center
Billing Code: 97761 (CPT)
- CPT Billing Code: 97761
- Insurance Median: $50
- Cash Discount Price: $56
- vs. Medicare Baseline: 1.24x 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 |
|---|---|---|
| Triwest -All Plans | $26 | 64% |
| Humana | $26 - $53 | 64% |
| Healthy Blue Mcr Adv | $26 | 64% |
| Va Ccn-All Plans | $26 | 64% |
| UnitedHealthcare | $36 - $56 | 89% |
| Blue Cross Blue Shield | $48 - $50 | 119% |
| Aetna | $50 | 124% |
| First Health - All Plans | $50 | 124% |
| Cigna | $53 | 131% |
| Healthy Blue Mcaid- All Other Plans | $56 | 139% |
| Coventry Mcaid-All Plans | $56 | 139% |
| Medicaid / KanCare | $56 | 139% |
| Providers Care-Wppa-All Plans | $84 | 208% |
Consumer Guidance & Cost Commentary
For CPT code 97761, representing prosthetic fitting and training, the gross charge at Ellsworth County Medical Center is $56.00. This amount aligns exactly with the cash median of $56.00 and the highest negotiated rates observed among payers such as Medicaid/KanCare and Coventry. While the facility's cash price matches the maximum negotiated amounts for several insurers, it is important to note that commercial negotiated rates often exceed cash prices due to administrative overhead and contract structures. In this specific case, the cash price is identical to the top-tier negotiated rates, meaning patients with high-deductible plans or those without insurance may find paying out-of-pocket the most cost-effective option, as they would avoid any potential balance billing or deductible co-pays associated with insurance claims.
The facility is a Critical Access Hospital in Ellsworth, KS, with a facility rating of 2. While the provided data does not include explicit state or county average figures for comparison, the cash median of $56.00 serves as a clear benchmark for self-pay patients. 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 reduce the final bill by 20% to 50% if paid in full upfront. Additionally, if you have insurance, verify your specific plan's allowed amount before scheduling, as some in-network contracts may result in higher out-of-pocket costs than the cash price, particularly if your deductible has not yet been met.