CMS Price Transparency Data

Prosthetic fitting and training

Facility: Pinckneyville Community Hospital

Billing Code: 97761 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97761
Insurance Median: $113
Cash Discount Price: $158
vs. Medicare Baseline: 2.80x Medicare

The contracted insurance negotiated median rate for a Prosthetic fitting and training at Pinckneyville Community Hospital is $113. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $158. Compared to the federal Medicare reimbursement reference rate of $40.41, this hospital’s rate is 2.80x the Medicare baseline. Located in 5383 State Route 154, Pinckneyville, IL.

Cash / Self-Pay

$158

Average discount available for prompt cash payment at this facility.

Insurance Median

$113

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: $158 (391%)

Insurance Median: $113 (280%)

Cash: $158 (391% of Medicare)

Ins. Median: $113 (280% 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 280% of the Medicare baseline (a markup of 180%). 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
Humana	$51 - $66	126%
Umwa Mcr Adv - All Plans	$51 - $66	126%
UnitedHealthcare	$51 - $147	126%
Wellcare Mcr Adv - All Plans	$51 - $66	126%
Aetna	$52 - $197	129%
Blue Cross Blue Shield	$99 - $197	245%
Healthlink Hmo	$108 - $141	267%
Phcs - All Other Plans	$112 - $147	277%
Cigna	$113 - $148	280%
Healthlink Ppo - All Other Plans	$113 - $148	280%
Healthlink Work Comp	$113 - $148	280%
Phcs Savility	$116 - $152	287%
Multiplan - All Plans	$123 - $161	304%
Ambetter / Centene	$197	488%
Medicaid / KanCare	$197	488%

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 $158.
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 Pinckneyville Community 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.