CMS Price Transparency Data

Prosthetic fitting and training

Facility: Kossuth Regional Health Center

Billing Code: 97761 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97761
Insurance Median: $81
Cash Discount Price: $76
vs. Medicare Baseline: 2.00x Medicare

The contracted insurance negotiated median rate for a Prosthetic fitting and training at Kossuth Regional Health Center is $81. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $76. Compared to the federal Medicare reimbursement reference rate of $40.41, this hospital’s rate is 2.00x the Medicare baseline. Located in 1515 South Phillips Street, Algona, IA.

Cash / Self-Pay

$76

Average discount available for prompt cash payment at this facility.

Insurance Median

$81

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: $76 (188%)

Insurance Median: $81 (200%)

Cash: $76 (188% of Medicare)

Ins. Median: $81 (200% 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.

Elevated Commercial Rate Alert (Value-Gap)

The negotiated rate at this facility is 200% of the Medicare baseline (a markup of 100%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.

Consult Patient Advocate

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
Humana	$36	89%
Mercy One - All Plans	$36	89%
Va Ccn - All Plans	$36	89%
Amerigroup Mcr Adv - All Other Plans	$37	92%
UnitedHealthcare	$37 - $72	92%
Health Partners New Bus - All Other Plans	$66	163%
Midlands Choice - All Plans	$66	163%
Medical Associates - All Plans	$81	200%
Preferred Health - All Plans	$81	200%
Aetna	$88 - $92	218%
Multiplan - All Plans	$90	223%
Health Partners Exisiting Bus	$92	228%
Molina Mcaid/Chip - All Plans	$98	243%
Amerigroup Mcaid	$99	245%
Blue Cross Blue Shield	$191 - $210	473%

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 $76.
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 Kossuth Regional Health 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.