CMS Price Transparency Data

Prosthetic fitting and training

Facility: Gundersen Lutheran Medical Center

Billing Code: 97761 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97761
Insurance Median: $78
Cash Discount Price: $63
vs. Medicare Baseline: 1.93x Medicare

The contracted insurance negotiated median rate for a Prosthetic fitting and training at Gundersen Lutheran Medical Center is $78. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $63. Compared to the federal Medicare reimbursement reference rate of $40.41, this hospital’s rate is 1.93x the Medicare baseline. Located in 1910 South Ave, La Crosse, WI.

Cash / Self-Pay

$63

Average discount available for prompt cash payment at this facility.

Insurance Median

$78

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$40.41

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $40.41 (100%)

Cash / Self-Pay: $63 (156%)

Insurance Median: $78 (193%)

Cash: $63 (156% of Medicare)

Ins. Median: $78 (193% of 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.

Billing Status

Remaining Deductible ($)

Your Coinsurance Rate (%)

Input your details and click calculate to compare out-of-pocket costs.

Commercial Insurance Negotiated Rates

Negotiated contract ranges established by major commercial carriers at this facility.

Carrier / Plan Group	Contract Rate Range	vs. Medicare Reference
Amerigroup	$15 - $52	37%
Blue Cross Blue Shield	$15 - $486	37%
Group Health Eau Claire	$15 - $149	37%
Group Health Of South Central	$15 - $133	37%
Icare	$15 - $52	37%
Iowa Total Care	$15	37%
Managed Health Service	$15	37%
Molina Health	$15	37%
UnitedHealthcare	$15 - $135	37%
Aetna	$52 - $158	129%
Medical Associates	$52 - $124	129%
Ucare	$52 - $133	129%
Medica	$55 - $127	136%
Dean Health Plan	$70	173%
Quartz	$70	173%
Health Partners	$83 - $147	205%
Midland Choice	$124	307%
Alliance	$130 - $220	322%
Claim Doc Llc	$133	329%
Wps Narrow Network	$135	334%
Cigna	$136	337%
Wps - Arise	$136	337%
Aspirus Arise Health	$138	341%
Allied National General	$141	349%
Preferred One	$141	349%
Wps Statewide	$141	349%
Coventry Health Care	$158	391%
Humana	$158	391%
Multiplan/Healtheos	$159	393%

Self-Pay Upfront Cash Action Plan

Request a "Self-Pay classification" with the billing desk before receiving care.
Ask for a written "Prompt-Pay Discount" agreement quoting the price of $63.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 97761.

Insurance In-Network Protection Plan

Contact your insurance company to confirm Gundersen Lutheran Medical Center is fully in-network.
Ask your insurer if "Prior Authorization" is required for CPT code 97761.
Confirm the specific physician or imaging center is also in-network (not just the hospital building).
Audit your Explanation of Benefits (EOB) against the final itemized hospital invoice.