CMS Price Transparency Data

Prosthetic fitting and training

Facility: Carle Foundation Hospital

Billing Code: 97761 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97761
Insurance Median: $103
Cash Discount Price: $205
vs. Medicare Baseline: 2.55x Medicare

The contracted insurance negotiated median rate for a Prosthetic fitting and training at Carle Foundation Hospital is $103. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $205. Compared to the federal Medicare reimbursement reference rate of $40.41, this hospital’s rate is 2.55x the Medicare baseline. Located in 611 West Park Street, Urbana, IL.

Cash / Self-Pay

$205

Average discount available for prompt cash payment at this facility.

Insurance Median

$103

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: $205 (507%)

Insurance Median: $103 (255%)

Cash: $205 (507% of Medicare)

Ins. Median: $103 (255% 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 255% of the Medicare baseline (a markup of 155%). 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
Meridian	$20 - $39	49%
Humana	$30 - $39	74%
Aetna	$31 - $172	77%
Blue Cross Blue Shield	$39 - $140	97%
Molina	$39 - $64	97%
UnitedHealthcare	$39 - $133	97%
Wellcare	$39	97%
Community Partners Health Plan (Cphp)	$118 - $127	292%
Cigna	$156 - $168	386%
Multiplan/Phcs	$160 - $172	396%
Healthlink	$170 - $183	421%

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 $205.
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 Carle Foundation 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.