CMS Price Transparency Data

Prosthetic fitting and training

Facility: Carewell Health Medical Center

Billing Code: 97761 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97761
Insurance Median: $46
Cash Discount Price: $152
vs. Medicare Baseline: 1.14x Medicare

The contracted insurance negotiated median rate for a Prosthetic fitting and training at Carewell Health Medical Center is $46. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $152. Compared to the federal Medicare reimbursement reference rate of $40.41, this hospital’s rate is 1.14x the Medicare baseline. Located in 300 Central Ave, East Orange, NJ.

Cash / Self-Pay

$152

Average discount available for prompt cash payment at this facility.

Insurance Median

$46

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: $152 (376%)

Insurance Median: $46 (114%)

Cash: $152 (376% of Medicare)

Ins. Median: $46 (114% 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
UnitedHealthcare	$30 - $106	74%
Wellcare	$30 - $46	74%
Amerigroup	$31 - $32	77%
Aetna	$34 - $154	84%
Clover	$46	114%
Horizon New Jersey Health	$46 - $60	114%
Oxford Health Plan	$100	247%
Blue Cross Blue Shield	$103	255%
Magnacare	$115 - $118	285%

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 $152.
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 Carewell Health 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.