Prosthetic fitting and training
Facility: Decatur Health
Billing Code: 97761 (CPT)
- CPT Billing Code: 97761
- Insurance Median: $98
- Cash Discount Price: $115
- vs. Medicare Baseline: 2.43x 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 243% of the Medicare baseline (a markup of 143%). 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 | $65 | 161% |
| Wppa/Providrs Care- All Plans | $77 | 191% |
| UnitedHealthcare | $78 - $98 | 193% |
| Humana | $79 | 195% |
| Midlands Choice- All Plans | $115 | 285% |
| Aetna | $115 - $128 | 285% |
| Medicaid / KanCare | $129 | 319% |
Consumer Guidance & Cost Commentary
For the CPT code 97761, "Prosthetic fitting and training," Decatur Health in Oberlin, KS, lists a cash median of $115.00 and a median negotiated rate of $98.00. While the facility is a Critical Access Hospital with a voluntary non-profit ownership structure, the cash price is notably higher than the state average of $88.00. This suggests that for patients with high-deductible plans, paying cash directly might be more cost-effective than using insurance, as the negotiated rate of $98.00 exceeds the cash price. However, patients should verify their specific plan's deductible status before assuming insurance will result in lower out-of-pocket costs, as many plans require the full negotiated amount to be paid before coverage begins.
To ensure you are receiving the most accurate pricing, it is important to distinguish between the facility's gross charges and the actual rates paid by insurers. The Medicare benchmark for this service is $40.41, which serves as a scientifically validated baseline for the true cost of care; commercial rates are often significantly higher than this figure due to administrative overhead and contract dynamics. If you choose to pay out-of-network or self-pay, you should explicitly request a "prompt-pay" discount before scheduling your visit, as hospitals often offer fee reductions for upfront payments that bypass the costly insurance billing cycle. Additionally, always review your itemized bill line-by-line to identify any errors or unbundled charges, as over 80% of hospital bills contain discrepancies that can be corrected through a formal written audit dispute.