Prosthetic fitting and training
Facility: Memorial Hospital
Billing Code: 97761 (CPT)
- CPT Billing Code: 97761
- Insurance Median: $112
- Cash Discount Price: $204
- vs. Medicare Baseline: 2.77x 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 277% of the Medicare baseline (a markup of 177%). 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 | $53 | 131% |
| Tricare | $102 | 252% |
| Humana | $102 | 252% |
| Medicare (plans) | $103 | 255% |
| Ambetter / Centene | $112 | 277% |
| Coventry - All Other Plans | $184 | 455% |
| Health Partners Of Kansas - All Plans | $194 | 480% |
| Preferred Healthcare-All Plans | $194 | 480% |
| Wppa/Providers Care-All Plans | $286 | 708% |
Consumer Guidance & Cost Commentary
For the CPT code 97761, "Prosthetic fitting and training," Memorial Hospital in Abilene, KS, lists a cash price of $204.00, which matches the facility's median negotiated rate of $112.00 for most payers. While the facility is a Critical Access Hospital with a government ownership structure, the cash price is notably higher than the median negotiated rate of $112.00, suggesting that paying out-of-pocket may not always be the most economical option for those with high-deductible plans. In this specific case, the cash price exceeds the negotiated amount paid by insurers like Ambetter/Centene ($112.00) and Humana ($102.00), meaning patients with active insurance coverage could potentially save money by utilizing their plan rather than paying cash. However, patients should always verify their specific plan's deductible status and allowed amounts before scheduling, as paying the full cash price without meeting a deductible could result in higher out-of-pocket costs than the insurance negotiated rate.
The facility's pricing does not align with typical commercial benchmarks, as the cash price of $204.00 is significantly higher than the Medicare benchmark of $40.41, reflecting a markup of 2.8 times the federal rate. This disparity highlights the importance of comparing rates against the Medicare baseline rather than the hospital's full chargemaster list, which often inflates the perceived value of discounts. For consumers concerned about unexpected costs, it is crucial to request an itemized billing audit before finalizing payment, as over 80% of hospital bills contain errors such as unbundled codes or services not rendered