Prosthetic fitting and training
Facility: Ascension Via Christi Rehabilitation Hospital Inc
Billing Code: 97761 (CPT)
- CPT Billing Code: 97761
- Insurance Median: $38
- Cash Discount Price: Unavailable
- vs. Medicare Baseline: 0.94x 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 |
|---|---|---|
| Medicare (plans) | $38 - $39 | 94% |
| Va | $38 | 94% |
| Vc Hope | $38 | 94% |
| Humana | $38 | 94% |
| Blue Cross Blue Shield | $39 | 97% |
| UnitedHealthcare | $39 - $106 | 97% |
| Smarthealth | $53 | 131% |
| Medicaid / KanCare | $65 | 161% |
| Aetna | $71 | 176% |
Consumer Guidance & Cost Commentary
For the CPT code 97761, Prosthetic fitting and training, the facility Ascension Via Christi Rehabilitation Hospital Inc in Wichita, KS, has a median negotiated rate of $38.00 across nine payers. This rate is consistent with the lowest and highest ranges reported for Medicare plans, the Department of Veterans Affairs, and several other commercial carriers, all of which fall between $38 and $39. While the facility does not list a specific cash or self-pay price in this dataset, patients should note that cash payments can sometimes be more cost-effective than insurance reimbursement if the patient's plan has a high deductible and the negotiated rate exceeds the cash price. It is advisable to contact the hospital directly to inquire about self-pay or prompt-pay discounts, which can range from 20% to 50% off the billed amount when paid in full upfront.
The Medicare benchmark for this service is $40.41, which serves as a reliable baseline for evaluating pricing fairness. Commercial negotiated rates generally average between 200% and 300% of Medicare, though fair pricing is often defined as 120% to 150% of this amount. In this specific case, the $38.00 negotiated rate is slightly below the Medicare benchmark, indicating a competitive price point relative to the federal standard. Patients should be aware that balance billing is largely prohibited for out-of-network services at in-network facilities under the No Surprises Act, but they should still request an itemized bill to ensure no unbundled charges or services not rendered are included. Disputing any unexpected line items via certified mail is the most effective way to reduce medical debt and avoid