CMS Price Transparency Data

Prosthetic fitting and training

Facility: St Mary's Medical Center

Billing Code: 97761 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97761
Insurance Median: $39
Cash Discount Price: $38
vs. Medicare Baseline: 0.97x Medicare

The contracted insurance negotiated median rate for a Prosthetic fitting and training at St Mary's Medical Center is $39. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $38. Compared to the federal Medicare reimbursement reference rate of $40.41, this hospital’s rate is 0.97x the Medicare baseline. Located in 201 Nw R D Mize Rd, Blue Springs, MO.

Cash / Self-Pay

$38

Average discount available for prompt cash payment at this facility.

Insurance Median

$39

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: $38 (94%)

Insurance Median: $39 (97%)

Cash: $38 (94% of Medicare)

Ins. Median: $39 (97% 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
UnitedHealthcare	$18 - $55	45%
Medicaid / KanCare	$35	87%
Blue Cross Blue Shield	$38 - $72	94%
Aetna	$39	97%
Cigna	$39	97%
Home State	$39 - $62	97%
Medicare (plans)	$39 - $41	97%
Tricare	$39	97%
Veterans Evaluation Services	$39	97%
Kansas Superior	$40	99%
Healthy Blue	$41 - $51	101%
Employer Direct Healthcare	$55	136%
6 Degrees	$78	193%

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 $38.
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 St Mary's Medical Center 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.