CMS Price Transparency Data

Prosthetic fitting and training

Facility: St Francis Hospital

Billing Code: 97761 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97761
Insurance Median: $184
Cash Discount Price: $165
vs. Medicare Baseline: 4.55x Medicare

The contracted insurance negotiated median rate for a Prosthetic fitting and training at St Francis Hospital is $184. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $165. Compared to the federal Medicare reimbursement reference rate of $40.41, this hospital’s rate is 4.55x the Medicare baseline. Located in 1215 Franciscan Dr, Litchfield, IL.

Cash / Self-Pay

$165

Average discount available for prompt cash payment at this facility.

Insurance Median

$184

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: $165 (408%)

Insurance Median: $184 (455%)

Cash: $165 (408% of Medicare)

Ins. Median: $184 (455% 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 455% of the Medicare baseline (a markup of 355%). 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
Wexford	$45	111%
Molina Healthcare	$47 - $50	116%
Clear Spring Health of Illinois	$48	119%
Blue Cross Blue Shield	$48 - $53	119%
Humana	$48	119%
Meridian Health Plan	$49	121%
UnitedHealthcare	$50 - $229	124%
Aetna	$50 - $161	124%
Amish Community	$64	158%
Celtic Insurance Company	$116	287%
Claim Doc	$120	297%
Hopetrust	$132	327%
Wellfirst	$147	364%
First Health	$170	421%
Caterpillar, Inc.	$184	455%
Current Health Solutions	$192	475%
Multiplan/Phcs	$195	483%
Healthlink	$195	483%
Consociate Group	$195	483%
Provider Network of America	$206	510%
Healthcare Finest Network (Hfn)	$206	510%
Interplan	$229	567%
Healthscope	$229	567%
Cigna	$229	567%
Health Alliance Medical Plans	$229	567%
Naphcare	$229	567%
Illinois Breast and Cervical Cancer Program	$229	567%
Live360	$229	567%

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 $165.
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 Francis 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.