Prosthetic fitting and training
Facility: Wamego Health Center
Billing Code: 97761 (CPT)
- CPT Billing Code: 97761
- Insurance Median: $26
- Cash Discount Price: $65
- vs. Medicare Baseline: 0.64x 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 |
|---|---|---|
| UnitedHealthcare | $20 | 49% |
| Medicaid / KanCare | $21 - $26 | 52% |
| Aetna | $21 | 52% |
| Providrs Care | $50 | 124% |
| Blue Cross Blue Shield | $66 - $70 | 163% |
Consumer Guidance & Cost Commentary
For the CPT code 97761, "Prosthetic fitting and training," Wamego Health Center in Wamego, KS, lists a cash median price of $65.00, which is significantly lower than the facility's gross charge of $162.00. When compared to the Medicare benchmark of $40.41, the cash rate represents a 60% increase over the federal baseline, aligning with the typical range where fair pricing is often defined as 120% to 150% of Medicare. While commercial payers like UnitedHealthcare and Aetna negotiate rates ranging from $20 to $26, these amounts remain higher than the cash price, illustrating that for patients with high-deductible plans or those without insurance, paying out-of-pocket may result in lower out-of-pocket costs. It is important to note that the facility does not list a specific median paid amount for insurance plans, and patients should verify their specific deductible status before assuming insurance will cover the service.
Patients should proactively request a "prompt-pay" discount or self-pay rate from the billing department before scheduling, as these upfront payment incentives can bypass the administrative overhead and multi-layered contract structures that often inflate insurance negotiated rates. Although the No Surprises Act protects patients from balance billing for out-of-network services at in-network facilities, it is crucial to confirm that the specific procedure and any ancillary services are covered under the patient's plan to avoid unexpected charges. Given that over 80% of hospital bills contain errors, consumers are advised to request a full, itemized CPT-coded bill rather than accepting a summary invoice, ensuring that all charges are accurate