Prosthetic fitting and training
Facility: Nemaha Valley Community Hospital
Billing Code: 97761 (CPT)
- CPT Billing Code: 97761
- Insurance Median: $51
- Cash Discount Price: $73
- vs. Medicare Baseline: 1.26x 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 |
|---|---|---|
| Va Ccn - All Plans | $26 - $45 | 64% |
| Humana | $26 - $45 | 64% |
| Aetna | $27 - $87 | 67% |
| Celtic Comm Exch - All Plans | $29 - $49 | 72% |
| Partners Direct Health - All Plans | $31 - $53 | 77% |
| Blue Cross Blue Shield | $50 | 124% |
| Multiplan - All Plans | $54 - $92 | 134% |
| Midlands Choice - All Plans | $57 - $97 | 141% |
| Health Partners - All Plans | $57 - $97 | 141% |
Consumer Guidance & Cost Commentary
For the CPT code 97761, "Prosthetic fitting and training," Nemaha Valley Community Hospital in Seneca, KS, lists a cash price of $73.00. This cash rate is notably higher than the facility's median negotiated rate of $51.00 and exceeds the state average for this service. While commercial payers like Aetna and Multiplan have negotiated rates ranging from $27 to $92, patients with high-deductible plans might find the cash price of $73.00 more affordable than the negotiated rates if their insurance has not yet met their deductible. It is important to note that commercial negotiated rates often include administrative overhead and contract dynamics that can inflate the baseline price by 20% to 40% compared to direct cash payments.
The facility's cash price of $73.00 is also significantly higher than the Medicare benchmark of $40.41, which serves as the objective baseline for healthcare costs in this region. Although the facility is a Critical Access Hospital and a voluntary non-profit, the markup relative to Medicare suggests that the commercial rates may be above the fair pricing range typically defined as 120% to 150% of Medicare. Patients should verify their specific plan's allowed amounts before scheduling, as in-network status does not guarantee the lowest possible price. Additionally, patients should inquire directly with the hospital about "self-pay" or "prompt-pay" discounts, which can reduce bills by 20% to 50% if paid upfront, effectively bypassing the costly insurance claims processing cycle.