Prosthetic fitting and training
Facility: William Newton Hospital
Billing Code: 97761 (CPT)
- CPT Billing Code: 97761
- Insurance Median: $46
- Cash Discount Price: $123
- vs. Medicare Baseline: 1.14x 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 |
|---|---|---|
| Triwest- All Plans | $43 | 106% |
| Ambetter / Centene | $44 - $123 | 109% |
| Blue Cross Blue Shield | $44 - $48 | 109% |
| UnitedHealthcare | $44 - $111 | 109% |
| Providrs Care Nexus | $75 | 186% |
| Providrs Care - All Other Plans | $86 | 213% |
Consumer Guidance & Cost Commentary
For the CPT code 97761, "Prosthetic fitting and training," William Newton Hospital in Winfield, KS, lists a cash price of $123.00, which matches the facility's median paid amount. This cash rate is significantly higher than the state average of $40.41 (Medicare amount) and the county average of $44.00 (median paid). While commercial insurance plans like Triwest and UnitedHealthcare negotiate rates ranging from $43 to $123, patients with high-deductible plans might find the cash price more affordable if their insurance negotiated rate exceeds $123.00. It is important to note that while the facility is a Critical Access Hospital with a government-local ownership structure, commercial payers often pay substantially more than the cash price due to administrative costs and contract dynamics, meaning paying out-of-pocket can sometimes result in lower total costs for the patient.
Patients should be aware that commercial negotiated rates can sometimes exceed cash prices due to the administrative overhead and multi-layered billing structures inherent in insurance contracts. To ensure you are receiving the best possible rate, you should explicitly ask the hospital about "self-pay" or "prompt-pay" discounts, which can reduce the bill by 20% to 50% if paid in full upfront. Additionally, if you have insurance, verify your specific plan's allowed amount before scheduling, as some in-network facilities may charge significantly more than others. If you receive a bill that appears to include charges for services not rendered or unbundled components, request a formal itemized audit to identify errors, as over 80% of hospital bills contain mistakes that can be corrected through