Prosthetic fitting and training
Facility: Greenwood County Hospital
Billing Code: 97761 (CPT)
- CPT Billing Code: 97761
- Insurance Median: $57
- Cash Discount Price: $54
- vs. Medicare Baseline: 1.41x 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 | $24 | 59% |
| Choicecare Mcr Adv - All Plans | $29 | 72% |
| UnitedHealthcare | $29 - $57 | 72% |
| Tricare | $29 | 72% |
| Blue Cross Blue Shield | $48 - $50 | 119% |
| Integrated Health Plan - All Plans | $51 | 126% |
| First Health Ccn Network | $58 | 144% |
| First Health - All Other Plans | $58 | 144% |
| Beech Street - All Plans | $58 | 144% |
| Preferred Hs (Coventry) - All Plans | $61 | 151% |
| Principal Health Care Inc - All Plans | $65 | 161% |
| Medicaid / KanCare | $68 | 168% |
| Amerigroup Mcaid-All Plans | $68 | 168% |
| Providrs Care/Wppa - All Plans | $102 | 252% |
Consumer Guidance & Cost Commentary
For CPT code 97761, "Prosthetic fitting and training," Greenwood County Hospital in Eureka, KS, lists a cash median price of $54.00, which is lower than the facility's negotiated rates of $57.00 paid by most insurers. While the facility is a Critical Access Hospital owned by the local government, patients with high-deductible plans may find paying the cash price directly more cost-effective than relying on insurance, as the negotiated rates often exceed the cash amount. It is important to note that while the No Surprises Act protects patients from balance billing for out-of-network services at in-network facilities, patients should still verify their specific plan details and ask the hospital directly about "self-pay" or "prompt-pay" discounts before scheduling, as these upfront payment incentives can further reduce the final cost.
The Medicare benchmark for this service is $40.41, which serves as a baseline for evaluating the facility's pricing markup. The facility's cash rate of $54.00 is approximately 1.4 times the Medicare amount, reflecting a standard commercial pricing structure where negotiated rates typically range from 200% to 300% of Medicare, though fair pricing is often defined between 120% and 150%. If a patient receives an itemized bill that includes unexpected charges or broad category summaries, they should request a full line-by-line audit to identify errors, unbundled codes, or services not rendered, as over 80% of hospital bills contain mistakes. Disputing these errors in writing rather than verbally can significantly reduce medical debt, ensuring the patient only pays for the actual care provided.