Prosthetic fitting and training
Facility: Clay County Medical Center
Billing Code: 97761 (CPT)
- CPT Billing Code: 97761
- Insurance Median: $59
- Cash Discount Price: $62
- vs. Medicare Baseline: 1.46x 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 | $57 | 141% |
| Wppa/Providrs Care- All Plans | $57 | 141% |
| UnitedHealthcare | $59 | 146% |
| Multiplan- All Plans | $59 | 146% |
| Health Partners - All Plans | $59 | 146% |
Consumer Guidance & Cost Commentary
For the CPT code 97761, "Prosthetic fitting and training," Clay County Medical Center in Clay Center, KS, lists a cash price of $62.00, which matches the facility's median negotiated rate of $59.00 and the cash median. This service is provided at a Critical Access Hospital with government-local ownership. While the facility's cash rate is competitive, patients should be aware that commercial insurance plans often pay negotiated rates that can exceed the cash price. For instance, the median negotiated amount across payers is $59.00, and some plans may have higher allowed amounts, meaning paying out-of-pocket could result in lower total costs for those with high-deductible plans. It is advisable to contact the hospital directly to confirm if "self-pay" or "prompt-pay" discounts are available before scheduling, as these upfront fee reductions can further lower the final bill.
The Medicare benchmark for this procedure is $40.41, which serves as a baseline for evaluating the facility's pricing markup. The facility's cash rate of $62.00 represents a 1.5x multiplier relative to the Medicare amount, indicating the cost basis for this service. When reviewing your specific plan, note that while the facility has contracted rates with major payers like Aetna, UnitedHealthcare, and others, these contracts do not guarantee the lowest possible price for every member. To avoid unexpected costs, patients should request an itemized bill if they receive a summary invoice, as over 80% of hospital bills contain errors such as unbundled codes or charges for services not rendered. If you receive a balance bill from an out-of-network provider,