CMS Price Transparency Data

Prosthetic fitting and training

Facility: Saint Joseph Hospital-Elgin

Billing Code: 97761 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97761
Insurance Median: $41
Cash Discount Price: $41
vs. Medicare Baseline: 1.01x Medicare

The contracted insurance negotiated median rate for a Prosthetic fitting and training at Saint Joseph Hospital-Elgin is $41. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $41. Compared to the federal Medicare reimbursement reference rate of $40.41, this hospital’s rate is 1.01x the Medicare baseline. Located in 77 N Airlite Street, Elgin, IL.

Cash / Self-Pay

$41

Average discount available for prompt cash payment at this facility.

Insurance Median

$41

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: $41 (101%)

Insurance Median: $41 (101%)

Cash: $41 (101% of Medicare)

Ins. Median: $41 (101% 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
Aetna	$31 - $43	77%
Blue Cross Blue Shield	$31 - $58	77%
Humana	$31 - $46	77%
Medicaid / KanCare	$31 - $33	77%
Meridian	$33 - $43	82%
Molina	$33 - $62	82%
Celtic (Wellcare)	$41	101%
Cigna	$41	101%
Clear Spring Health Of Illinois	$41	101%
Devoted Health	$41	101%
Essential Health Partners	$41 - $48	101%
Longevity Health Plan Of Illinois	$41	101%
Medicare (plans)	$41	101%
Ravenswood Physicians Associates Ipa	$41	101%
Resurrection Physicians Provider Group Ipa	$41	101%
Self-Pay	$41	101%
Tricare	$41	101%
United Behavioral	$41	101%
UnitedHealthcare	$41 - $52	101%
Providers Partners Health Plan (Pphp)	$43	106%
Zing Health Provider Network	$43	106%
Harmony Health Plan	$44	109%
Access Community Health Network	$50	124%
Clifton Health Systems	$64	158%
Ambetter / Centene	$67	166%
Imagine Health Network, Inc	$149	369%
Community Partners Health Plan	$161	398%

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 $41.
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 Saint Joseph Hospital-Elgin 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.