CMS Price Transparency Data

Prosthetic fitting and training

Facility: St Mary Medical Center

Billing Code: 97761 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97761
Insurance Median: $72
Cash Discount Price: $127
vs. Medicare Baseline: 1.78x Medicare

The contracted insurance negotiated median rate for a Prosthetic fitting and training at St Mary Medical Center is $72. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $127. Compared to the federal Medicare reimbursement reference rate of $40.41, this hospital’s rate is 1.78x the Medicare baseline. Located in Langhorne-Newtown Rd, Langhorne, PA.

Cash / Self-Pay

$127

Average discount available for prompt cash payment at this facility.

Insurance Median

$72

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: $127 (314%)

Insurance Median: $72 (178%)

Cash: $127 (314% of Medicare)

Ins. Median: $72 (178% 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
Pace-Trinity Health	$25	62%
Medicaid / KanCare	$33 - $72	82%
UnitedHealthcare	$41 - $103	101%
Blue Cross Blue Shield	$42 - $62	104%
Cigna	$42 - $358	104%
Align Senior Care	$43	106%
Medicare (plans)	$43 - $76	106%
Aetna	$44 - $174	109%
Health America Advantra	$50	124%
Amerihealth	$62	153%
Blue Shield - Ca	$62	153%
Blue Shield - Id (Regence)	$62	153%
Blue Shield - Ny Highmark Western	$62	153%
Blue Shield - Wa (Regence)	$62	153%
Keystone First	$72	178%
Keystone First Chip	$72	178%
Ambetter / Centene	$75	186%
Jefferson Health Plan Commercial	$76	188%
Oscar	$76	188%
Prime Healthcare	$76	188%
Homestead Health Plans Woods Center	$82	203%
Group Pension Administrators	$94	233%
Reedman Toll	$94	233%
Geha	$103	255%
Blue Shield - Pa (Highmark)	$113	280%
Meritain	$174	431%
Multiplan	$176	436%
Prime Health Services	$176	436%
Galaxy Health Network	$185	458%
Three Rivers Provider Network	$185	458%
Upmc Health Plan	$358	886%
Webtpa	$358	886%

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 $127.
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 Mary Medical 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.