CMS Price Transparency Data

Prosthetic fitting and training

Facility: Advocate Sherman Hospital

Billing Code: 97761 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97761
Insurance Median: $97
Cash Discount Price: $85
vs. Medicare Baseline: 2.40x Medicare

The contracted insurance negotiated median rate for a Prosthetic fitting and training at Advocate Sherman Hospital is $97. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $85. Compared to the federal Medicare reimbursement reference rate of $40.41, this hospital’s rate is 2.40x the Medicare baseline. Located in 1425 North Randall Road, Elgin, IL.

Cash / Self-Pay

$85

Average discount available for prompt cash payment at this facility.

Insurance Median

$97

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: $85 (210%)

Insurance Median: $97 (240%)

Cash: $85 (210% of Medicare)

Ins. Median: $97 (240% 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 240% of the Medicare baseline (a markup of 140%). 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
Ambetter / Centene	$60	148%
Molina	$60	148%
Oscar Health Hmo	$62	153%
Advocate Employee	$67 - $74	166%
Blue Cross Blue Shield	$68 - $99	168%
Hstechnology	$80	198%
Cigna	$88 - $112	218%
Aetna	$98	243%
Private Healthcare Systems	$138	341%
Multiplan	$153	379%
UnitedHealthcare	$212 - $268	525%

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 $85.
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 Advocate Sherman 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.