Prosthetic fitting and training
Facility: Phillips County Hospital
Billing Code: 97761 (CPT)
- CPT Billing Code: 97761
- Insurance Median: $62
- Cash Discount Price: $58
- vs. Medicare Baseline: 1.53x 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 |
|---|---|---|
| Blue Cross Blue Shield | $50 - $55 | 124% |
| UnitedHealthcare | $54 - $68 | 134% |
| Medicaid / KanCare | $68 | 168% |
| Health Partners-All Plans | $68 | 168% |
Consumer Guidance & Cost Commentary
For the CPT code 97761, "Prosthetic fitting and training," Phillips County Hospital in Phillipsburg, KS, lists a gross charge of $68.00. While the facility's cash median rate is $58.00 and the median negotiated rate across four payers is $62.00, these figures are notably higher than the Medicare benchmark of $40.41. This indicates a markup of 1.5 times the Medicare rate. It is important to note that commercial insurance rates often exceed cash prices due to administrative costs and contract structures; therefore, patients with high-deductible plans or those who have met their out-of-pocket maximum may find paying the cash price of $58.00 directly to the hospital more cost-effective than relying on insurance, which could result in higher allowed amounts.
To minimize potential costs, patients should proactively contact the hospital to inquire about "self-pay" or "prompt-pay" discounts, which can reduce the final bill by 20% to 50% if paid in full upfront. Additionally, if you are using insurance, be aware that the No Surprises Act protects you from balance billing for out-of-network services at in-network facilities, though you should still verify your specific plan's allowed amount before scheduling. If you receive a summary bill, do not accept it as final; instead, request a detailed, itemized statement to identify any errors, unbundled codes, or services not rendered, as over 80% of hospital bills contain inaccuracies that can be corrected through a formal written audit dispute.