CMS Price Transparency Data

Prosthetic fitting and training

Facility: Riverview Medical Center

Billing Code: 97761 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97761
Insurance Median: $151
Cash Discount Price: $52
vs. Medicare Baseline: 3.74x Medicare

The contracted insurance negotiated median rate for a Prosthetic fitting and training at Riverview Medical Center is $151. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $52. Compared to the federal Medicare reimbursement reference rate of $40.41, this hospital’s rate is 3.74x the Medicare baseline. Located in One Riverview Plaza, Red Bank, NJ.

Cash / Self-Pay

$52

Average discount available for prompt cash payment at this facility.

Insurance Median

$151

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: $52 (129%)

Insurance Median: $151 (374%)

Cash: $52 (129% of Medicare)

Ins. Median: $151 (374% 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 374% of the Medicare baseline (a markup of 274%). 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	$27 - $151	67%
Clover	$35	87%
Blue Cross Blue Shield	$42	104%
Seoul Medical Group	$42	104%
Amerigroup	$52	129%
Vaccn	$52	129%
United Community/Americhoice	$55	136%
Horizon	$60 - $156	148%
UnitedHealthcare	$63 - $382	156%
Karna	$69	171%
Horizon - Jri@Rmc	$138	341%
Qualcare	$150 - $306	371%
Cigna	$154 - $185	381%
Activecare First McO	$164	406%
Multiplan - PHCS	$164	406%
Amerihealth	$167 - $189	413%
Brighton Health Plan	$174	431%
Wellcare	$224	554%
Bergen Risk	$291	720%
Oxford	$464	1148%

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 $52.
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 Riverview 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.