CMS Price Transparency Data

Prosthetic fitting and training

Facility: Elkhart General Hospital

Billing Code: 97761 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97761
Insurance Median: $108
Cash Discount Price: $106
vs. Medicare Baseline: 2.67x Medicare

The contracted insurance negotiated median rate for a Prosthetic fitting and training at Elkhart General Hospital is $108. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $106. Compared to the federal Medicare reimbursement reference rate of $40.41, this hospital’s rate is 2.67x the Medicare baseline. Located in 600 E Blvd, Elkhart, IN.

Cash / Self-Pay

$106

Average discount available for prompt cash payment at this facility.

Insurance Median

$108

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: $106 (262%)

Insurance Median: $108 (267%)

Cash: $106 (262% of Medicare)

Ins. Median: $108 (267% 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 267% of the Medicare baseline (a markup of 167%). 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
Mclaren (Mi	$21	52%
UnitedHealthcare	$21 - $110	52%
Blue Cross Blue Shield	$33 - $73	82%
Devoted Healthcare	$33 - $40	82%
Aetna	$38 - $110	94%
Humana	$38 - $114	94%
Pace	$38	94%
Plain Church	$58 - $130	144%
Caresource	$61 - $212	151%
Mhs	$69 - $212	171%
Cha	$98 - $127	243%
Immergrun	$98 - $130	243%
Php	$106 - $114	262%
Cigna	$117 - $124	290%
Multiplan	$117	290%
Signature	$119	294%
Encore	$121	299%
Heartland	$163	403%
Mdwise	$212	525%

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 $106.
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 Elkhart General 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.