Prosthetic fitting and training
Facility: Children'S Mercy South
Billing Code: 97761 (CPT)
- CPT Billing Code: 97761
- Insurance Median: $122
- Cash Discount Price: $90
- vs. Medicare Baseline: 3.02x 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 302% of the Medicare baseline (a markup of 202%). 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 |
|---|---|---|
| UnitedHealthcare | $21 - $126 | 52% |
| Healthy Blue | $23 - $109 | 57% |
| Medicaid / KanCare | $24 | 59% |
| Blue Cross Blue Shield | $77 - $139 | 191% |
| Cigna | $90 - $131 | 223% |
| Home State Health | $96 | 238% |
| Medica | $110 | 272% |
| Aetna | $113 - $128 | 280% |
| Wellfit/Centrus | $122 | 302% |
| Wppa Providrs Care | $122 | 302% |
| Nebraska Furniture Mart | $122 | 302% |
| Quiktrip | $122 | 302% |
| Health Midwest Comprehensive Care | $122 | 302% |
| Orscheln | $122 | 302% |
| Centivo | $122 | 302% |
| Humana | $125 | 309% |
| Coventry Health Care Of Kansas | $139 | 344% |
| Coxhealth Network | $139 | 344% |
| Mercy Health | $141 | 349% |
| Multiplan | $143 | 354% |
| American Healthcare Alliance | $160 | 396% |
| Healthlink | $165 | 408% |
| National Preferred Provider Network | $169 | 418% |
Consumer Guidance & Cost Commentary
For the CPT code 97761, Prosthetic fitting and training, Children's Mercy South in Overland Park, KS, offers a cash price of $90.00, which is significantly lower than the facility's negotiated rates. While the facility's median negotiated rate is $122.00, the cash price provides a clear alternative for patients who may not have insurance or have high-deductible plans where the insurance allowed amount could exceed the cash cost. It is important to note that the facility's cash price is 223% higher than the Medicare benchmark of $40.41, illustrating that while cash is cheaper than insurance, it still represents a substantial markup over the federal cost baseline. Patients should verify if their specific insurance plan allows a lower negotiated rate than the facility's standard contract, as some commercial payers may offer amounts closer to the cash price.
The data indicates that this service is widely covered across 23 different payers, with negotiated rates ranging from $21 to $169 depending on the insurance carrier. For instance, UnitedHealthcare has a low-end negotiated rate of $21, while National Preferred Provider Network charges up to $169. Given that the facility is a voluntary non-profit, patients should proactively ask about "self-pay" or "prompt-pay" discounts before scheduling, as these incentives can further reduce the final bill. To ensure you are not overcharged, request an itemized bill that breaks down the exact CPT code and unit costs, avoiding summary bills that obscure individual charges. If you receive a bill that seems inflated, you can dispute it in writing to the billing supervisor, as over 80%