Prosthetic fitting and training
Facility: Bob Wilson Memorial Hospital
Billing Code: 97761 (CPT)
- CPT Billing Code: 97761
- Insurance Median: $73
- Cash Discount Price: $34
- vs. Medicare Baseline: 1.81x 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 |
|---|---|---|
| UnitedHealthcare | $26 - $76 | 64% |
| Kansas Health | $26 - $29 | 64% |
| Medicare (plans) | $26 - $29 | 64% |
| Aetna | $26 - $73 | 64% |
| Humana | $26 - $29 | 64% |
| Blue Cross Blue Shield | $67 | 166% |
| Centura Employee Plan | $72 | 178% |
| Multiplan | $73 - $85 | 181% |
| Health Partners Of Kansas | $76 - $86 | 188% |
| Wppa | $77 - $87 | 191% |
Consumer Guidance & Cost Commentary
For the CPT code 97761, "Prosthetic fitting and training," Bob Wilson Memorial Hospital in Ulysses, KS, lists a gross charge of $86.00. The facility's cash median price is $34.00, which is significantly lower than the negotiated rates paid by commercial payers. While the median negotiated rate across all payers is $73.00, individual contracts vary widely; for instance, UnitedHealthcare and Aetna have negotiated rates ranging from $26 to $76, whereas Blue Cross Blue Shield and Centura Employee Plan have fixed negotiated rates of $67 and $72, respectively. This disparity highlights that being in-network does not guarantee the lowest possible price, as some commercial contracts can exceed the cash-pay amount, potentially making self-pay a more cost-effective option for patients with high-deductible plans.
When evaluating the facility's pricing against federal benchmarks, the Medicare amount for this service is $40.41. The facility's cash price of $34.00 is below the Medicare benchmark, suggesting a rate that aligns closely with the "true cost" of delivery rather than the inflated chargemaster often used for comparison. However, the gross charge of $86.00 represents a substantial markup over the Medicare rate. Patients should be aware that the No Surprises Act protects against balance billing for out-of-network providers at in-network facilities, but it is crucial to verify the status of any ancillary services, such as lab work or specific supplies, which may be billed separately. To minimize costs, patients are encouraged to request a prompt-pay discount or self-pay classification before scheduling, as