CMS Price Transparency Data

Prosthetic fitting and training

Facility: Alton Memorial Hospital

Billing Code: 97761 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97761
Insurance Median: $83
Cash Discount Price: $67
vs. Medicare Baseline: 2.05x Medicare

The contracted insurance negotiated median rate for a Prosthetic fitting and training at Alton Memorial Hospital is $83. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $67. Compared to the federal Medicare reimbursement reference rate of $40.41, this hospital’s rate is 2.05x the Medicare baseline. Located in One Memorial Drive, Alton, IL.

Cash / Self-Pay

$67

Average discount available for prompt cash payment at this facility.

Insurance Median

$83

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: $67 (166%)

Insurance Median: $83 (205%)

Cash: $67 (166% of Medicare)

Ins. Median: $83 (205% 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 205% of the Medicare baseline (a markup of 105%). 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
Aetna	$39 - $332	97%
Blue Cross Blue Shield	$39 - $216	97%
Essence Healthcare [221]	$39	97%
Humana	$39 - $62	97%
UnitedHealthcare	$39 - $127	97%
Cox Health [757]	$41	101%
Devoted Health Plan [847]	$41	101%
Medica [662]	$41	101%
Healthlink [225]	$54 - $84	134%
Cox Health Systems Insurance Company [220]	$61 - $72	151%
Health Alliance [224]	$61	151%
Allied Benefits [498]	$64 - $332	158%
Hope Trust [806]	$64	158%
Med-Pay [480]	$72 - $83	178%
Unicare [568]	$72 - $84	178%
First Health Commercial [734]	$82	203%
Beechstreet [551]	$83	205%
Detego Health [868]	$83	205%
Health Systems Inc [620]	$83	205%
Healthcare Sol Mercy [609]	$83	205%
Multiplan Commercial [737]	$83	205%
Multiplan [240]	$83	205%
Phcs [244]	$83 - $89	205%
Preferred Health Professionals [561]	$84	208%
Cigna	$89 - $328	220%
Hfn [563]	$89	220%
Medica [661]	$89	220%
Healthscope Benefits [258]	$127	314%
Consociate [478]	$237	586%
Sarah Bush Lincoln [636]	$237	586%
Apwu Health Plan [216]	$328	812%
Nalc Health Benefit Plan [242]	$328	812%
Priority Health [648]	$328	812%
Coresource [497]	$332	822%
Fmh Benefit Service Inc [222]	$332	822%
Mail Handlers [495]	$332	822%

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 $67.
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 Alton Memorial 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.