Prosthetic fitting and training
Facility: Jewell County Hospital
Billing Code: 97761 (CPT)
- CPT Billing Code: 97761
- Insurance Median: $99
- Cash Discount Price: $79
- vs. Medicare Baseline: 2.45x 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 245% of the Medicare baseline (a markup of 145%). 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 |
|---|---|---|
| Rural Carriers - All Plans | $88 - $91 | 218% |
| Aetna | $94 - $96 | 233% |
| Meritain - All Plans | $94 - $96 | 233% |
| Cigna | $99 - $102 | 245% |
| Midlands Choice - All Plans | $99 - $102 | 245% |
| First Health - All Plans | $99 - $102 | 245% |
| UnitedHealthcare | $99 - $102 | 245% |
Consumer Guidance & Cost Commentary
For the procedure of prosthetic fitting and training at Jewell County Hospital in Mankato, KS, the facility's cash price of $79.00 is notably lower than the state average of $99.00. While the median negotiated rate for in-network insurance plans is $99.00, patients with high-deductible plans may find paying the cash price upfront more cost-effective, as the insurance negotiated rate often exceeds the cash price. To secure this lower rate, patients should explicitly request "self-pay" or "prompt-pay" discounts before scheduling, as billing systems may default to insurance processing once a card is on file. Signing a waiver to prevent automatic claims submission is essential to ensure the facility applies the cash discount rather than submitting a claim that would result in the higher negotiated amount.
This service is benchmarked against Medicare, which sets a fixed reimbursement rate of $40.41 for this CPT code, indicating that the facility's cash price represents a significant markup over the federal baseline. Although the facility is a Critical Access Hospital owned by the local government, the cash rate remains higher than the Medicare amount, reflecting the administrative costs and profit margins inherent in private billing. Patients should be aware that while the No Surprises Act protects against balance billing for out-of-network providers at in-network facilities, it does not prevent balance billing for services rendered by out-of-network physicians or ancillary providers within the hospital. To avoid unexpected costs, consumers should request a full itemized bill before paying and verify that all services listed were actually rendered to identify any potential errors or unbundled charges.