CMS Price Transparency Data

Prosthetic fitting and training

Facility: St John's Riverside Hospital

Billing Code: 97761 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97761
Insurance Median: $46
Cash Discount Price: $230
vs. Medicare Baseline: 1.14x Medicare

The contracted insurance negotiated median rate for a Prosthetic fitting and training at St John's Riverside Hospital is $46. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $230. Compared to the federal Medicare reimbursement reference rate of $40.41, this hospital’s rate is 1.14x the Medicare baseline. Located in 976 North Broadway, Yonkers, NY.

Cash / Self-Pay

$230

Average discount available for prompt cash payment at this facility.

Insurance Median

$46

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: $230 (569%)

Insurance Median: $46 (114%)

Cash: $230 (569% of Medicare)

Ins. Median: $46 (114% 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
Fidelis Essential Plans	$39	97%
Medicaid / KanCare	$39	97%
Fidelis Health Benefit Exchange	$44	109%
Aetna	$46 - $3,783	114%
Centers Plan For Healthy Living	$46	114%
Fidelis	$46	114%
Healthfirst	$46	114%
Hip Health Plan	$46	114%
Magnacare	$46	114%
Medicare (plans)	$46	114%
Mvp	$46	114%
Mvp Bhs	$46	114%
Oscar	$46 - $48	114%
Partners Health Plan	$46	114%
United Behavioral Health Of Ny Ipa	$46	114%
Village Caremax	$46	114%
Wellcare	$46	114%
Metroplus Gold	$48	119%
Emblem Health	$124 - $207	307%
Empire Hmo	$134	332%
Mvp Individual Exchange.Student Health Plan	$148	366%
UnitedHealthcare	$169 - $171	418%
Mvp Commercial	$175	433%
Cigna	$207	512%

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 $230.
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 John's Riverside 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.