Prosthetic fitting and training
Facility: Community Memorial Healthcare, Inc.
Billing Code: 97761 (CPT)
- CPT Billing Code: 97761
- Insurance Median: $42
- Cash Discount Price: $61
- vs. Medicare Baseline: 1.04x 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 |
|---|---|---|
| Aetna | $28 - $49 | 69% |
| UnitedHealthcare | $35 | 87% |
| Blue Cross Blue Shield | $50 | 124% |
Consumer Guidance & Cost Commentary
For the CPT code 97761, "Prosthetic fitting and training," Community Memorial Healthcare, Inc. in Marysville, KS, lists a cash median price of $61.00, which matches the facility's gross charge. This cash rate is notably higher than the state average for this service, as the cash median for the state is $40.41. However, patients with high-deductible plans should consider that paying cash upfront may be more cost-effective than using insurance, since the median negotiated rate paid by insurers is $35.00. By paying directly, patients could potentially save money if their insurance allows them to use the lower negotiated amount, though they must verify their specific plan's coverage limits before scheduling.
The facility offers a median negotiated rate of $42.00 across three payers, including Aetna, UnitedHealthcare, and Blue Cross Blue Shield, with individual plan ranges varying between $28 and $50. While the facility is an in-network Critical Access Hospital, patients should be aware that commercial rates often include administrative overhead that can exceed the true cost of care. To minimize out-of-pocket expenses, it is advisable to contact the hospital directly to inquire about "self-pay" or "prompt-pay" discounts, which can reduce the final bill by 20% to 50% if paid in full within a short window. Additionally, patients should request an itemized bill to ensure all charges are accurate and to identify any potential errors before finalizing payment.