Prosthetic fitting and training
Facility: Amberwell Atchison Association
Billing Code: 97761 (CPT)
- CPT Billing Code: 97761
- Insurance Median: $86
- Cash Discount Price: $168
- vs. Medicare Baseline: 2.13x 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 213% of the Medicare baseline (a markup of 113%). 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 | $48 - $50 | 119% |
| Triwest - All Plans | $55 | 136% |
| UnitedHealthcare | $55 - $301 | 136% |
| Humana | $55 - $76 | 136% |
| Va Ccn - All Plans | $55 | 136% |
| Superior Select Mcr Adv - All Plans | $55 | 136% |
| Ambetter / Centene | $86 | 213% |
| Cigna | $92 | 228% |
| Aetna | $92 | 228% |
| Centrus Health Direct - All Plans | $126 | 312% |
| Oscar - All Plans | $126 | 312% |
| Multiplan - All Plans | $131 | 324% |
| Wppa Providrs Care - All Plans | $151 | 374% |
Consumer Guidance & Cost Commentary
For the CPT code 97761, "Prosthetic fitting and training," Amberwell Atchison Association in Atchison, KS, lists a cash price of $168.00, which matches the facility's cash median. This cash rate is significantly higher than the Medicare benchmark of $40.41, reflecting a markup common in commercial pricing where negotiated rates often average 200% to 300% of the federal baseline. While the facility's negotiated rates with major payers like UnitedHealthcare and Humana range from $55 to $301, patients with high-deductible plans may find the cash price more affordable if their insurance allowed amount exceeds $168.00. It is important to verify your specific plan's allowed amount before scheduling, as assuming in-network status guarantees the lowest price can lead to unexpected costs if the insurer's negotiated rate is higher than the cash option.
Patients should proactively inquire about "self-pay" or "prompt-pay" discounts, which can reduce bills by 20% to 50% when paid in full upfront, bypassing the administrative overhead of insurance claims processing. Since over 80% of hospital bills contain errors, requesting a detailed, itemized statement is crucial to identify unbundled codes or services not rendered before making a payment. Although the data does not provide specific county or state average comparisons for this procedure, the facility's cash rate of $168.00 serves as a clear baseline for comparison against your personal insurance allowed amount. Always review your itemized bill for accuracy and do not sign away your rights to dispute balance billing or out-of-network charges without understanding