CMS Price Transparency Data

Prosthetic fitting and training

Facility: Margaretville Memorial Hospital

Billing Code: 97761 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97761
Insurance Median: $147
Cash Discount Price: $164
vs. Medicare Baseline: 3.64x Medicare

The contracted insurance negotiated median rate for a Prosthetic fitting and training at Margaretville Memorial Hospital is $147. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $164. Compared to the federal Medicare reimbursement reference rate of $40.41, this hospital’s rate is 3.64x the Medicare baseline. Located in 42084 State Highway 28, Margaretville, NY.

Cash / Self-Pay

$164

Average discount available for prompt cash payment at this facility.

Insurance Median

$147

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: $164 (406%)

Insurance Median: $147 (364%)

Cash: $164 (406% of Medicare)

Ins. Median: $147 (364% 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 364% of the Medicare baseline (a markup of 264%). 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	$72 - $210	178%
Mvp Gold (McR)	$72	178%
Blue Cross Blue Shield	$72 - $201	178%
Medicare (plans)	$72 - $108	178%
Hamaspik (McR)	$72	178%
UnitedHealthcare	$72 - $176	178%
Affinity By Molina McR	$76	188%
Cdphp	$79	195%
Magnacare Standard	$115	285%
Todays Options	$119	294%
Self-Pay	$125	309%
Multiplan	$134	332%
Oxford	$147 - $165	364%
First Health	$148	366%
Emblem Select Care (Exchange)	$154	381%
Emblem Ghi/Hip Ppo/Cbp	$156	386%
Oxford Exchange	$158	391%
Mvp	$174	431%
Emblem Ghi/Hip Hmo/Epo/Pos	$181	448%
Emblem	$230 - $270	569%
Mvp Exchange	$238	589%
Mvp Hmo/Ppo	$280	693%
Magnacare	$390	965%
Magnacare Preferred	$413	1022%

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 $164.
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 Margaretville Memorial 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.