CMS Price Transparency Data

Prosthetic fitting and training

Facility: Metropolitan Hospital Center

Billing Code: 97761 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97761
Insurance Median: $123
Cash Discount Price: Unavailable
vs. Medicare Baseline: 3.04x Medicare

The contracted insurance negotiated median rate for a Prosthetic fitting and training at Metropolitan Hospital Center is $123. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is unavailable. Compared to the federal Medicare reimbursement reference rate of $40.41, this hospital’s rate is 3.04x the Medicare baseline. Located in 1901 First Avenue, New York, NY.

Cash / Self-Pay

Unavailable

Average discount available for prompt cash payment at this facility.

Insurance Median

$123

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%)

Insurance Median: $123 (304%)

Ins. Median: $123 (304% 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 304% of the Medicare baseline (a markup of 204%). 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	$20 - $192	49%
United	$23 - $330	57%
Local 1199	$30 - $254	74%
Healthfirst	$37 - $221	92%
Amidacare	$47 - $98	116%
Emblem	$47 - $228	116%
Wellcare	$50 - $179	124%
Metroplus	$58 - $221	144%
Fidelis	$67 - $221	166%
Oscar	$70 - $251	173%
Blue Cross Blue Shield	$98 - $239	243%
Carelon	$98 - $194	243%
Senior Whole Health	$98	243%
United Behavioral Health	$98 - $108	243%
Affinity	$100 - $221	247%
Carelon (Amida Care)	$100	247%
Vnsny	$100 - $254	247%
Centerlight	$149	369%
Elderplan	$194	480%
Villagecare Max	$209	517%
Magnacare	$224	554%
Oxford	$236 - $265	584%
Multiplan	$239	591%
Cigna	$241	596%

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 $X.
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 Metropolitan Hospital 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.