CMS Price Transparency Data

Prosthetic fitting and training

Facility: St Mary's Healthcare

Billing Code: 97761 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97761
Insurance Median: $51
Cash Discount Price: $59
vs. Medicare Baseline: 1.26x Medicare

The contracted insurance negotiated median rate for a Prosthetic fitting and training at St Mary's Healthcare is $51. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $59. Compared to the federal Medicare reimbursement reference rate of $40.41, this hospital’s rate is 1.26x the Medicare baseline. Located in 427 Guy Park Avenue, Amsterdam, NY.

Cash / Self-Pay

$59

Average discount available for prompt cash payment at this facility.

Insurance Median

$51

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: $59 (146%)

Insurance Median: $51 (126%)

Cash: $59 (146% of Medicare)

Ins. Median: $51 (126% 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
Carelon_Commercial	$34 - $52	84%
Carelon_Empire	$34 - $52	84%
Medicare (plans)	$39 - $44	97%
Tricare	$39	97%
Va	$39	97%
Blue Cross Blue Shield	$40 - $73	99%
Aetna	$41 - $214	101%
Humana	$41	101%
Excellus_Commercial	$50 - $77	124%
Emblem_Commercial	$51 - $78	126%
Medicaid / KanCare	$63 - $70	156%
UnitedHealthcare	$63	156%
Cdphp_Commercial	$114	282%

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 $59.
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 Healthcare 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.