Prosthetic fitting and training
Facility: Salina Regional Health Center
Billing Code: 97761 (CPT)
- CPT Billing Code: 97761
- Insurance Median: $184
- Cash Discount Price: $143
- vs. Medicare Baseline: 4.55x 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 455% of the Medicare baseline (a markup of 355%). 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 |
|---|---|---|
| Blue Cross Blue Shield | $53 - $56 | 131% |
| Preferred Phsic | $122 | 302% |
| Preferred Healthcare - All Other Plans | $165 | 408% |
| Multiplan (Mpi)-All Plans | $184 | 455% |
| Providers Care (Wppa)-All Plans | $184 | 455% |
| Aetna | $184 | 455% |
| Cigna | $184 | 455% |
Consumer Guidance & Cost Commentary
For the CPT code 97761, representing prosthetic fitting and training, Salina Regional Health Center in Salina, KS, has a gross charge of $204.00. While the facility's median negotiated rate of $184.00 is consistent with the state average, the cash-pay median of $143.00 is notably lower. This price difference highlights a potential opportunity for patients with high-deductible plans, as paying cash upfront can sometimes result in a lower out-of-pocket cost than the insurance negotiated rate, provided the patient qualifies for a self-pay or prompt-pay discount. To secure the best possible rate, patients should contact the hospital directly before scheduling to confirm if a prompt-pay discount is available and request a waiver of insurance submission to avoid automatic claims processing.
The facility's pricing is benchmarked against the federal Medicare rate of $40.41, which serves as a baseline for evaluating commercial markups. Although the data does not provide specific county or state average figures for this specific procedure, the facility's cash price of $143.00 remains significantly below the gross charge of $204.00, reflecting the administrative costs and contract structures inherent in insurance billing. Patients should be aware that while the No Surprises Act protects against balance billing for out-of-network services at in-network facilities, it is essential to review itemized bills carefully to ensure no unbundled codes or services not rendered are included. Disputing any discrepancies in writing with the billing supervisor is the most effective way to verify that the final invoice aligns with the negotiated or cash rates discussed during registration.