CMS Price Transparency Data

Prosthetic fitting and training

Facility: NYU Langone Hospitals

Billing Code: 97761 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97761
Insurance Median: $219
Cash Discount Price: $53
vs. Medicare Baseline: 5.42x Medicare

The contracted insurance negotiated median rate for a Prosthetic fitting and training at NYU Langone Hospitals is $219. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $53. Compared to the federal Medicare reimbursement reference rate of $40.41, this hospital’s rate is 5.42x the Medicare baseline. Located in 550 First Avenue, New York, NY.

Cash / Self-Pay

$53

Average discount available for prompt cash payment at this facility.

Insurance Median

$219

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: $53 (131%)

Insurance Median: $219 (542%)

Cash: $53 (131% of Medicare)

Ins. Median: $219 (542% 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 542% of the Medicare baseline (a markup of 442%). 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
1199	$30	74%
Fidelis	$42 - $256	104%
Healthfirst	$42 - $256	104%
Healthplus	$42 - $256	104%
Ghi	$46 - $360	114%
Hip	$46 - $360	114%
Medicare (plans)	$46 - $47	114%
Wellcare	$46 - $47	114%
Amida	$47	116%
Centerlight	$47 - $48	116%
Metroplus	$64 - $256	158%
Hamaspik	$69 - $70	171%
Medicaid / KanCare	$70 - $114	173%
UnitedHealthcare	$70 - $381	173%
Somos	$73 - $154	181%
Multiplan	$219 - $220	542%
Blue Cross Blue Shield	$226 - $283	559%
Oscar	$239	591%
Aetna	$280 - $313	693%
Oxford	$308 - $358	762%
Magnacare	$370 - $596	916%
Cigna	$393	973%

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 $53.
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 NYU Langone Hospitals 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.