CMS Price Transparency Data

Prosthetic fitting and training

Facility: St Joseph's Hospital

Billing Code: 97761 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97761
Insurance Median: $78
Cash Discount Price: $76
vs. Medicare Baseline: 1.93x Medicare

The contracted insurance negotiated median rate for a Prosthetic fitting and training at St Joseph's Hospital is $78. 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 1.93x the Medicare baseline. Located in 12866 Troxler Avenue, Highland, IL.

Cash / Self-Pay

$76

Average discount available for prompt cash payment at this facility.

Insurance Median

$78

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: $78 (193%)

Cash: $76 (188% of Medicare)

Ins. Median: $78 (193% 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.

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
Molina Healthcare	$21 - $73	52%
Sae Hospice	$21	52%
Aetna	$21 - $73	52%
Humana	$21	52%
UnitedHealthcare	$21 - $105	52%
Blue Cross Blue Shield	$21	52%
Clear Spring Health of Illinois	$21	52%
Amish Community	$29	72%
Naphcare	$44	109%
Celtic Insurance Company	$46	114%
Hopetrust	$52	129%
Claim Doc	$52	129%
Wellfirst	$67	166%
Cigna	$70	173%
Meridian Health Plan	$76	188%
First Health	$78	193%
Healthlink	$89	220%
Multiplan/Phcs	$89	220%
Healthcare Finest Network (Hfn)	$94	233%
Provider Network of America	$94	233%
Health Alliance Medical Plans	$105	260%
Qtc Medical Group of Illinois	$105	260%
Mental Health Network	$105	260%
Current Health Solutions	$105	260%
Interplan	$105	260%
Caterpillar, Inc.	$105	260%
Illinois Breast and Cervical Cancer Program	$105	260%
Consociate Group	$105	260%
Healthscope	$105	260%

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 St Joseph's Hospital 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.