Prosthetic fitting and training
Facility: Lincoln County Hospital
Billing Code: 97761 (CPT)
- CPT Billing Code: 97761
- Insurance Median: $51
- Cash Discount Price: $71
- vs. Medicare Baseline: 1.26x 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 | 124% |
Consumer Guidance & Cost Commentary
For the CPT code 97761, "Prosthetic fitting and training," Lincoln County Hospital lists a cash median price of $71.00, which is notably lower than the facility's gross charge of $79.00. While the hospital is a Critical Access Hospital in Lincoln, KS, and is government-owned, there is no median negotiated rate available for this specific service in the current data. However, the Medicare benchmark for this procedure is $40.41, and the facility's cash price represents a 75% markup relative to that federal baseline. It is important to note that while commercial insurance contracts often average between 200% and 300% of Medicare rates, the cash price here is significantly below those typical commercial markups, making it a potentially cost-effective option for patients who have not yet met their deductible or are paying out-of-pocket.
Patients should verify whether "self-pay" or "prompt-pay" discounts are available before scheduling, as these upfront payment incentives can further reduce the final bill by bypassing administrative claim processing fees. Since the data shows only one payer, Blue Cross Blue Shield, with a narrow range of $50.00, it is crucial to confirm if this negotiated rate applies to your specific plan or if you might face balance billing if you are out-of-network. Given that over 80% of hospital bills contain errors, we recommend requesting a detailed, itemized statement to ensure no unbundled codes or services not rendered are included. Always check your deductible status and compare the facility's rates against local averages to ensure you are receiving fair pricing for your care.