CMS Price Transparency Data

Prosthetic fitting and training

Facility: Decatur Memorial Hospital

Billing Code: 97761 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97761
Insurance Median: $56
Cash Discount Price: $121
vs. Medicare Baseline: 1.39x Medicare

The contracted insurance negotiated median rate for a Prosthetic fitting and training at Decatur Memorial Hospital is $56. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $121. Compared to the federal Medicare reimbursement reference rate of $40.41, this hospital’s rate is 1.39x the Medicare baseline. Located in 2300 North Edward Street, Decatur, IL.

Cash / Self-Pay

$121

Average discount available for prompt cash payment at this facility.

Insurance Median

$56

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: $121 (299%)

Insurance Median: $56 (139%)

Cash: $121 (299% of Medicare)

Ins. Median: $56 (139% 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
Blue Cross Blue Shield	$29 - $121	72%
Aetna	$38 - $81	94%
Coventry	$38 - $73	94%
Health Alliance	$38 - $80	94%
Humana	$38 - $79	94%
Medicare (plans)	$38	94%
Tricare	$38 - $39	94%
UnitedHealthcare	$38 - $121	94%
Veterans Administration	$38	94%
Wellcare	$38	94%
Medicaid / KanCare	$45 - $46	111%
Illinois Workers Compensation	$47 - $64	116%
Caterpillar	$48	119%
Mennonite Churches	$52	129%
Plain Church Medical Group	$54	134%
Cigna	$56	139%
Health Alliance Mh Employee Plan	$56	139%
Commercial Workers Compensation	$61	151%
Hfn	$61 - $91	151%
6 Degrees Health	$73	181%
Hopetrust	$73	181%
Hst	$73	181%
Phcs Savility	$79	195%
Phcs Multiplan Ppo	$82	203%
Healthlink	$83	205%
Corvel	$87	215%
Consociate	$90	223%
Liability	$121	299%

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 $121.
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 Decatur 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.