Prosthetic fitting and training
Facility: Clara Barton Hospital
Billing Code: 97761 (CPT)
- CPT Billing Code: 97761
- Insurance Median: $90
- Cash Discount Price: $70
- 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 | $50 | 124% |
| 6 Degrees Health - All Plans | $70 | 173% |
| Wppa-All Plans | $80 | 198% |
| UnitedHealthcare | $90 | 223% |
| Phcs - All Plans | $90 | 223% |
| Aetna | $90 | 223% |
| Hlth Partners Of Ks-All Plans | $92 | 228% |
Consumer Guidance & Cost Commentary
For the CPT code 97761, "Prosthetic fitting and training," Clara Barton Hospital in Hoisington, KS, lists a gross charge of $100.00. While the facility's cash median rate is $70.00, the negotiated rates for in-network payers average $90.00, which is higher than the cash price. This pricing structure highlights a common billing dynamic where commercial insurance contracts often exceed cash-pay rates due to administrative costs and contract dynamics. For patients with high-deductible plans, paying the $70.00 cash rate directly could result in significant savings compared to the $90.00 amount allowed by insurance, provided the patient's out-of-pocket costs are high enough to make the difference meaningful.
The facility's pricing is also notable when compared to federal benchmarks; the Medicare amount for this service is $40.41, meaning the cash rate represents a 71% markup over the government baseline. Patients should be aware that while the No Surprises Act protects against balance billing for emergency care at in-network facilities, it does not apply to elective procedures like prosthetic fitting. To minimize costs, consumers should explicitly ask the hospital about "self-pay" or "prompt-pay" discounts before scheduling, as these upfront payment incentives can further reduce the final bill. Additionally, if a patient receives an itemized bill, they should request a full line-by-line audit to ensure no unbundled codes or services not rendered are included, as over 80% of hospital bills contain errors that can be corrected.