CMS Price Transparency Data

Prosthetic fitting and training

Facility: Capital Health Medical Center - Hopewell

Billing Code: 97761 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97761
Insurance Median: $45
Cash Discount Price: $268
vs. Medicare Baseline: 1.11x Medicare

The contracted insurance negotiated median rate for a Prosthetic fitting and training at Capital Health Medical Center - Hopewell is $45. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $268. Compared to the federal Medicare reimbursement reference rate of $40.41, this hospital’s rate is 1.11x the Medicare baseline. Located in One Capital Way, Pennington, NJ.

Cash / Self-Pay

$268

Average discount available for prompt cash payment at this facility.

Insurance Median

$45

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: $268 (663%)

Insurance Median: $45 (111%)

Cash: $268 (663% of Medicare)

Ins. Median: $45 (111% 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
Medicaid / KanCare	$11	27%
UnitedHealthcare	$11 - $368	27%
Wellpoint	$12 - $43	30%
Aetna	$14 - $81	35%
Blue Cross Blue Shield	$27 - $32	67%
Clover	$43	106%
Humana	$44	109%
Medicare (plans)	$45	111%
Horizon Nj Health	$60	148%
Fidelis	$70	173%
Oxford Benefit Plan	$109	270%
Cigna	$177 - $295	438%
Multiplan	$228	564%

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 $268.
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 Capital Health Medical Center - Hopewell 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.