CMS Price Transparency Data

Prosthetic fitting and training

Facility: Columbia Memorial Hospital

Billing Code: 97761 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97761
Insurance Median: $90
Cash Discount Price: $55
vs. Medicare Baseline: 2.23x Medicare

The contracted insurance negotiated median rate for a Prosthetic fitting and training at Columbia Memorial Hospital is $90. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $55. Compared to the federal Medicare reimbursement reference rate of $40.41, this hospital’s rate is 2.23x the Medicare baseline. Located in 71 Prospect Avenue, Hudson, NY.

Cash / Self-Pay

$55

Average discount available for prompt cash payment at this facility.

Insurance Median

$90

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: $55 (136%)

Insurance Median: $90 (223%)

Cash: $55 (136% of Medicare)

Ins. Median: $90 (223% 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 223% of the Medicare baseline (a markup of 123%). 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
Aetna	$41 - $185	101%
Blue Cross Blue Shield	$42 - $176	104%
Empire Plan Nyship	$53 - $154	131%
Emblem	$58 - $94	144%
Nascentia Health Options	$60 - $66	148%
Cdphp	$65 - $214	161%
Hamaspik	$71 - $129	176%
Magnacare	$84	208%
Blue Shield	$90 - $178	223%
Fidelis	$95 - $214	235%
Medicaid / KanCare	$95	235%
Multiplan	$98	243%
UnitedHealthcare	$154	381%
Mvp Commercial	$162 - $165	401%
Mvp	$200	495%

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 $55.
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 Columbia Memorial 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.