Prosthetic fitting and training
Facility: St Luke Hospital & Living Center
Billing Code: 97761 (CPT)
- CPT Billing Code: 97761
- Insurance Median: $32
- Cash Discount Price: Unavailable
- vs. Medicare Baseline: 0.79x 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 |
|---|---|---|
| UnitedHealthcare | $32 | 79% |
| Blue Cross Blue Shield | $32 | 79% |
| Bluestem Pace | $32 | 79% |
| Kansas Department Of Health And Environment | $32 | 79% |
| Humana | $32 | 79% |
| Ambetter / Centene | $32 | 79% |
| Va Ccn | $32 | 79% |
Consumer Guidance & Cost Commentary
For the CPT code 97761, "Prosthetic fitting and training," St Luke Hospital & Living Center in Marion, KS, has a negotiated rate of $32.00, which matches the lowest and highest paid amounts across all seven payers including UnitedHealthcare and Blue Cross Blue Shield. This negotiated rate is significantly lower than the facility's gross charge of $63.00, reflecting the standard administrative and contract structures that keep in-network costs predictable for members. While the facility is a Critical Access Hospital owned by a Government Hospital District, the data does not provide specific cash or median paid values for this service, so patients should verify their specific plan's deductible status before assuming the $32.00 rate will apply to their out-of-pocket costs.
When evaluating pricing, it is important to compare rates against the Medicare benchmark rather than the hospital's gross list price. For this procedure, the Medicare amount is $40.41, which serves as the objective baseline for fair pricing. Commercial negotiated rates often average between 200% and 300% of Medicare, though this specific facility's rate of $32.00 is below the Medicare benchmark, indicating a favorable contract structure. Patients with high-deductible plans may find that paying the cash price directly could be cheaper than the insurance negotiated rate if the cash price falls below the $32.00 threshold, though current data does not list a specific cash price. To maximize savings, patients should ask the billing department about "self-pay" or "prompt-pay" discounts, which can reduce bills by 20% to 50% when paid upfront, and request a full itemized