Prosthetic fitting and training
Facility: Hiawatha Community Hospital
Billing Code: 97761 (CPT)
- CPT Billing Code: 97761
- Insurance Median: $131
- Cash Discount Price: $168
- vs. Medicare Baseline: 3.24x 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.
Elevated Commercial Rate Alert (Value-Gap)
The negotiated rate at this facility is 324% of the Medicare baseline (a markup of 224%). 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 | $48 - $50 | 119% |
| UnitedHealthcare | $62 - $144 | 153% |
| Aetna | $62 - $136 | 153% |
| Humana | $63 | 156% |
| Ambetter / Centene | $75 | 186% |
| Oscar - All Plans | $126 | 312% |
| Centrus Health Direct - All Plans | $126 | 312% |
| Preferred Hlth - All Plans | $151 | 374% |
| Cigna | $160 | 396% |
| Wppa Providrs Care - All Plans | $160 | 396% |
| Multiplan - All Plans | $163 | 403% |
| Midlands Choice - All Plans | $163 | 403% |
| Healthy Blue Mcaid - All Plans | $168 | 416% |
Consumer Guidance & Cost Commentary
For the CPT code 97761, "Prosthetic fitting and training," Hiawatha Community Hospital in Hiawatha, KS, lists a cash price of $168.00, which matches the facility's gross charge and the state median. While the facility is a Critical Access Hospital with a voluntary non-profit ownership structure, the cash rate is notably higher than the state average, which sits at $136.00. For patients with high-deductible plans, paying the cash price of $168.00 upfront may be more cost-effective than using insurance, as the negotiated rates for in-network payers like UnitedHealthcare and Aetna range from $62.00 to $144.00, but these amounts are subject to deductibles and copays that could ultimately exceed the cash rate.
The facility's negotiated rates vary significantly across the 13 insurance plans reviewed, with the lowest allowed amount being $48.00 from Blue Cross Blue Shield and the highest at $168.00 from Healthy Blue Mcaid. When compared to the Medicare benchmark of $40.41, the cash price represents a markup of 3.2 times the Medicare rate, illustrating the typical administrative and profit margins inherent in commercial billing. To minimize costs, patients should verify if "self-pay" or "prompt-pay" discounts are available before scheduling, as paying in full can sometimes bypass the administrative overhead associated with insurance claims processing.