CMS Price Transparency Data

Prosthetic fitting and training

Facility: Carolina East Medical Center

Billing Code: 97761 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97761
Insurance Median: $63
Cash Discount Price: $59
vs. Medicare Baseline: 1.56x Medicare

The contracted insurance negotiated median rate for a Prosthetic fitting and training at Carolina East Medical Center is $63. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $59. Compared to the federal Medicare reimbursement reference rate of $40.41, this hospital’s rate is 1.56x the Medicare baseline. Located in 2000 Neuse Blvd, New Bern, NC.

Cash / Self-Pay

$59

Average discount available for prompt cash payment at this facility.

Insurance Median

$63

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: $59 (146%)

Insurance Median: $63 (156%)

Cash: $59 (146% of Medicare)

Ins. Median: $63 (156% 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
Pamlico Co Jail-All Plans	$19 - $34	47%
UnitedHealthcare	$24 - $90	59%
Humana	$39	97%
Inclusive Health (Nchirp)-All Plans	$39	97%
Tricare	$39 - $126	97%
Craven Co. Jail Systems - All Plans	$42 - $46	104%
Medcost Ppo Employees And Retirees	$46 - $83	114%
Medcost Ppo Ultra (Employees)	$46 - $79	114%
Blue Cross Blue Shield	$49 - $86	121%
Medcost Ppo City Employees	$51 - $92	126%
Medcost Ppo County Employee	$53 - $95	131%
Benefit Mgmt, Svcs-All Plans	$60 - $107	148%
Aetna	$62 - $112	153%
Medcost Benefit Svc-All Other Plans	$62 - $111	153%
Acs Consult Svc Inc-All Plans	$63 - $114	156%
Medcost Ppo Standard	$63 - $114	156%
Cigna	$64 - $115	158%

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 $59.
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 Carolina East 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.