Prosthetic fitting and training
Facility: Cloud County Health Center
Billing Code: 97761 (CPT)
- CPT Billing Code: 97761
- Insurance Median: $194
- Cash Discount Price: $143
- vs. Medicare Baseline: 4.80x 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 480% of the Medicare baseline (a markup of 380%). 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 |
|---|---|---|
| Aetna | $184 - $190 | 455% |
| Pponext-All Plans | $194 | 480% |
| Health Partners - All Plans | $194 | 480% |
| Mpi-All Plans | $194 | 480% |
Consumer Guidance & Cost Commentary
For the CPT code 97761, "Prosthetic fitting and training," Cloud County Health Center in Concordia, KS, lists a gross charge of $204.00. While the facility's cash median rate is $143.00, the negotiated rates for in-network payers like Aetna and Pponext-All Plans are set at $194.00. This creates a scenario where paying cash directly may be more cost-effective than using insurance, as the cash price is significantly lower than the insurer's allowed amount. Patients with high-deductible plans should consider paying the cash rate upfront to avoid the administrative overhead and potential higher negotiated fees associated with insurance billing.
To understand the true cost relative to federal standards, it is important to compare these rates against the Medicare benchmark. The Medicare amount for this service is $40.41, which serves as the objective baseline for evaluating pricing markups. The facility's cash rate of $143.00 represents approximately 354% of the Medicare rate, while the negotiated rate of $194.00 is roughly 480% of the Medicare amount. Although specific county or state average data was not provided in the report, patients are encouraged to request an itemized bill to verify that no unbundled codes or services not rendered are included, ensuring the final charge aligns with the transparent rates listed.