Prosthetic fitting and training
Facility: Stanton County Hospital
Billing Code: 97761 (CPT)
- CPT Billing Code: 97761
- Insurance Median: $95
- Cash Discount Price: $100
- vs. Medicare Baseline: 2.35x 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 235% of the Medicare baseline (a markup of 135%). 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 - $95 | 119% |
| Healthy Blue Mcr Adv - All Other Plans | $98 | 243% |
| Healthy Blue Mcaid | $100 | 247% |
Consumer Guidance & Cost Commentary
For the CPT code 97761, Prosthetic fitting and training, Stanton County Hospital in Johnson, KS, has a cash median price of $100.00, which matches the gross charge. This cash rate is notably higher than the state average of $96.00, though it aligns closely with the county average of $95.00. While commercial payers like Blue Cross Blue Shield negotiate rates ranging from $48 to $95, and Healthy Blue plans pay between $98 and $100, patients with high-deductible plans might find paying the full cash price of $100.00 more cost-effective than relying on insurance, as the negotiated rates for these insurers often exceed the cash amount.
To ensure you are receiving fair pricing, it is important to understand that Medicare sets a benchmark of $40.41 for this service, which is significantly lower than the facility's cash or negotiated rates. Commercial rates typically range from 200% to 300% of the Medicare amount, whereas fair pricing is generally defined as 120% to 150% of the Medicare rate. Before scheduling, patients should explicitly ask the hospital about "self-pay" or "prompt-pay" discounts, which can reduce the bill by 20% to 50% if paid upfront, bypassing the administrative costs associated with insurance claims processing. Additionally, if you receive a summary bill, request a full itemized statement to verify that no unbundled codes or services not rendered are included, as these are common sources of billing errors.