Prosthetic fitting and training
Facility: Logan County Hospital
Billing Code: 97761 (CPT)
- CPT Billing Code: 97761
- Insurance Median: $172
- Cash Discount Price: $50
- vs. Medicare Baseline: 4.26x 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.
Elevated Commercial Rate Alert (Value-Gap)
The negotiated rate at this facility is 426% of the Medicare baseline (a markup of 326%). 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 | $50 | 124% |
| Humana | $106 | 262% |
| Health Partners - All Plans | $238 | 589% |
| Medicaid / KanCare | $250 | 619% |
Consumer Guidance & Cost Commentary
For this procedure, the negotiated rates for Blue Cross Blue Shield, Humana, and Health Partners range from $50 to $238, while Medicaid/KanCare pays the full gross amount of $250. These commercial rates are significantly higher than the Medicare benchmark of $40.41, reflecting the administrative costs and contract structures that commercial insurers use to cover their share of care. In contrast, the cash-pay median is $50, which is substantially lower than the negotiated rates for most commercial payers. This price difference highlights a common billing dynamic where patients with high-deductible plans might save money by paying the cash price directly, provided they can afford the upfront cost, as the insurance negotiated rates often exceed the cash price due to multi-layered administrative structures.
It is important to note that while the facility is a Critical Access Hospital in Logan County, KS, the specific negotiated rates for this service vary by payer and do not align with a single state or county average provided in the data. Patients should verify their specific plan's allowed amount before scheduling to ensure they are not paying more than necessary. Additionally, since the facility is government-owned, patients should proactively ask about "self-pay" or "prompt-pay" discounts, which can reduce the final bill by offering immediate liquidity incentives. Always request an itemized bill to review the exact CPT codes and avoid balance billing surprises, as federal protections like the No Surprises Act may apply depending on the specific services rendered and network status.