CMS Price Transparency Data

Prosthetic fitting and training

Facility: Carle Eureka Hospital

Billing Code: 97761 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97761
Insurance Median: $74
Cash Discount Price: $155
vs. Medicare Baseline: 1.83x Medicare

The contracted insurance negotiated median rate for a Prosthetic fitting and training at Carle Eureka Hospital is $74. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $155. Compared to the federal Medicare reimbursement reference rate of $40.41, this hospital’s rate is 1.83x the Medicare baseline. Located in 101 S Major St, Eureka, IL.

Cash / Self-Pay

$155

Average discount available for prompt cash payment at this facility.

Insurance Median

$74

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: $155 (384%)

Insurance Median: $74 (183%)

Cash: $155 (384% of Medicare)

Ins. Median: $74 (183% 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
Meridian	$16 - $74	40%
Humana	$30 - $70	74%
Aetna	$31 - $102	77%
Molina	$31 - $74	77%
Wellcare	$39	97%
UnitedHealthcare	$70 - $96	173%
Community Partners Health Plan (Cphp)	$93	230%
Cigna	$96	238%
Healthlink	$101	250%
Blue Cross Blue Shield	$104 - $130	257%
Multiplan/Phcs	$116	287%

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 $155.
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 Eureka 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.