CMS Price Transparency Data

Prosthetic fitting and training

Facility: Queens Hospital Center

Billing Code: 97761 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97761
Insurance Median: $115
Cash Discount Price: $53
vs. Medicare Baseline: 2.85x Medicare

The contracted insurance negotiated median rate for a Prosthetic fitting and training at Queens Hospital Center is $115. 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 2.85x the Medicare baseline. Located in 82-68 164Th Street, Jamaica, NY.

Cash / Self-Pay

$53

Average discount available for prompt cash payment at this facility.

Insurance Median

$115

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: $115 (285%)

Cash: $53 (131% of Medicare)

Ins. Median: $115 (285% 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 285% of the Medicare baseline (a markup of 185%). 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%
Healthfirst	$23 - $258	57%
United	$23 - $330	57%
Local 1199	$30 - $254	74%
Affinity	$41 - $258	101%
Amidacare	$46 - $115	114%
Blue Cross Blue Shield	$46 - $258	114%
Centerlight	$46 - $149	114%
Elderplan	$46 - $194	114%
Emblem	$46 - $228	114%
Fidelis	$46 - $258	114%
Wellcare	$47 - $179	116%
Centers Plan For Healthy Living	$48	119%
Hamaspik	$49	121%
Metroplus	$58 - $258	144%
Oscar	$58 - $251	144%
Carelon	$115 - $194	285%
Senior Whole Health	$115	285%
United Behavioral Health	$115 - $126	285%
Carelon (Amida Care)	$117	290%
Vnsny	$117 - $254	290%
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 $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 Queens 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.