Prosthetic fitting and training
Facility: Clearsky Rehabilitation Hospital Of Elwood St Joseph Llc
Billing Code: 97761 (CPT)
- CPT Billing Code: 97761
- Insurance Median: $77
- Cash Discount Price: Unavailable
- vs. Medicare Baseline: 1.91x 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 |
|---|---|---|
| Multiplan | $73 | 181% |
| Cigna | $81 | 200% |
Consumer Guidance & Cost Commentary
For the CPT code 97761, "Prosthetic fitting and training," Clearsky Rehabilitation Hospital Of Elwood St Joseph Llc has a negotiated rate of $77.00 with two payers, Cigna and Multiplan. This negotiated amount is significantly higher than the Medicare benchmark of $40.41, reflecting the standard administrative markup inherent in commercial contracts. While the facility does not list a specific cash or self-pay rate in this report, patients with high-deductible plans should be aware that paying cash directly can sometimes result in lower out-of-pocket costs if the insurance negotiated rate exceeds the cash price. It is crucial to contact the hospital directly to confirm if "self-pay" or "prompt-pay" discounts are available before scheduling, as these upfront incentives can bypass the higher administrative costs associated with insurance billing.
This service is provided at a facility in Elwood, Kansas, and the data reflects the specific pricing dynamics for this location. Although the report does not provide explicit state or county average figures for comparison, the presence of a Medicare benchmark allows for an objective assessment of the facility's pricing relative to federal cost standards. Under the No Surprises Act, patients are protected from balance billing for out-of-network providers at in-network facilities, but they should still review their itemized bills carefully. If a bill arrives that includes unexpected charges, patients should request a full itemized audit to identify any unbundled codes or services not rendered, ensuring they are only paying for the agreed-upon care rather than inflated chargemaster rates.