Prosthetic fitting and training
Facility: Lindsborg Community Hospital
Billing Code: 97761 (CPT)
- CPT Billing Code: 97761
- Insurance Median: $187
- Cash Discount Price: $143
- vs. Medicare Baseline: 4.63x 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 463% of the Medicare baseline (a markup of 363%). 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 | $50 | 124% |
| Tricare | $96 | 238% |
| Coventry Mcr Adv | $97 | 240% |
| Cigna | $173 | 428% |
| UnitedHealthcare | $184 | 455% |
| Coventry Comm-All Other Plans | $184 | 455% |
| Multiplan-All Plans | $190 | 470% |
| Phcs Preferred-All Plans | $190 | 470% |
| Health Partners -All Plans | $194 | 480% |
| Century Health-All Plans | $194 | 480% |
| Coventry Wc | $194 | 480% |
| Wppa-All Plans | $194 | 480% |
Consumer Guidance & Cost Commentary
For the CPT code 97761 (Prosthetic fitting and training) at Lindsborg Community Hospital, the cash price is $143.00, which is lower than the median negotiated rate of $190.00 and the median paid amount of $190.00. While the facility is a Critical Access Hospital in Lindsborg, KS, the data provided does not include specific county or state average comparisons for this procedure. Patients with high-deductible plans or those without insurance may find the cash price more affordable than their insurance coverage, as the negotiated rates from payers like Blue Cross Blue Shield ($50.00) and Tricare ($96.00) are significantly higher than the cash rate. It is important to note that while some insurance plans may cover this service, the actual amount paid by the insurer varies by plan; for instance, Coventry Mcr Adv and Cigna each allow $97.00 and $173.00 respectively, whereas UnitedHealthcare and Coventry Comm-All Other Plans allow $184.00.
The Medicare benchmark for this service is $40.41, which serves as a baseline to evaluate the facility's pricing markup. The commercial negotiated rates range from $50.00 to $194.00 across twelve different payers, with the highest allowed amounts coming from Health Partners, Century Health, Coventry Wc, Wppa-All Plans, and others at $194.00. Because the cash price of $143.00 is well below the highest negotiated rates, patients should inquire about self