CMS Price Transparency Data

Prosthetic fitting and training

Facility: Valley West Community Hospital

Billing Code: 97761 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97761
Insurance Median: $143
Cash Discount Price: $179
vs. Medicare Baseline: 3.54x Medicare

The contracted insurance negotiated median rate for a Prosthetic fitting and training at Valley West Community Hospital is $143. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $179. Compared to the federal Medicare reimbursement reference rate of $40.41, this hospital’s rate is 3.54x the Medicare baseline. Located in 11 East Pleasant Avenue, Sandwich, IL.

Cash / Self-Pay

$179

Average discount available for prompt cash payment at this facility.

Insurance Median

$143

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: $179 (443%)

Insurance Median: $143 (354%)

Cash: $179 (443% of Medicare)

Ins. Median: $143 (354% 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 354% of the Medicare baseline (a markup of 254%). 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
Blue Cross Blue Shield	$18 - $209	45%
Cigna	$18 - $124	45%
Countycare Il Cook Co [1607]	$18	45%
Family Health Network Hmo [1610]	$18	45%
Medicaid / KanCare	$18	45%
Meridian Health Plan Hmo [1604]	$18	45%
Global Excel [1712]	$49	121%
Humana	$49	121%
Aetna	$65 - $177	161%
Health'S Finest Network [126]	$115 - $218	285%
UnitedHealthcare	$129 - $256	319%
The Alliance [1703]	$139	344%
Choicecare [177]	$173	428%
Healthlink [125]	$192	475%
Multiplan/Phcs [142]	$205 - $256	507%
First Health Plan [6034]	$256	634%

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 $179.
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 Valley West 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.