CMS Price Transparency Data

Prosthetic fitting and training

Facility: Riverside Community Hospital

Billing Code: 97761 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97761
Insurance Median: $51
Cash Discount Price: $641
vs. Medicare Baseline: 1.26x Medicare

The contracted insurance negotiated median rate for a Prosthetic fitting and training at Riverside Community Hospital is $51. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $641. Compared to the federal Medicare reimbursement reference rate of $40.41, this hospital’s rate is 1.26x the Medicare baseline. Located in 4445 Magnolia Avenue, Riverside, CA.

Cash / Self-Pay

$641

Average discount available for prompt cash payment at this facility.

Insurance Median

$51

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: $641 (1586%)

Insurance Median: $51 (126%)

Cash: $641 (1586% of Medicare)

Ins. Median: $51 (126% 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
Bristol Hospice	$34	84%
Medcare Partners	$40 - $152	99%
Blue Shield	$41 - $81	101%
Aetna	$42 - $182	104%
Alignment Health Plan	$43	106%
Blue Cross Blue Shield	$43	106%
Brand New Day	$43	106%
Central Health Plan	$43	106%
Clever Care Of Golden State	$43	106%
Easy Choice Health Plan	$43	106%
Health Net	$43 - $226	106%
Heritage Provider Network	$43 - $59	106%
Humana	$43	106%
Redlands Community Hospital	$43	106%
Riverside Medical Clinic	$43 - $51	106%
Riverside Physician	$43	106%
Scan Health Plan	$43	106%
Triwest Healthcare Alliance	$43	106%
UnitedHealthcare	$43	106%
Care1St Health Plan	$44	109%
United	$44 - $266	109%
Corvel Corporation	$50	124%
Healthsmart	$51 - $811	126%
Next	$51 - $811	126%
Inland Empire Health Plan	$73	181%
Bright Health	$106 - $401	262%
First Health	$118 - $912	292%
American Health System	$121 - $456	299%
Multiplan	$215 - $861	532%

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 $641.
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 Riverside Community 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.