CMS Price Transparency Data

Prosthetic fitting and training

Facility: Adventist Health and Rideout

Billing Code: 97761 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97761
Insurance Median: $149
Cash Discount Price: $38
vs. Medicare Baseline: 3.69x Medicare

The contracted insurance negotiated median rate for a Prosthetic fitting and training at Adventist Health and Rideout is $149. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $38. Compared to the federal Medicare reimbursement reference rate of $40.41, this hospital’s rate is 3.69x the Medicare baseline. Located in 726 4Th St, Marysville, CA.

Cash / Self-Pay

$38

Average discount available for prompt cash payment at this facility.

Insurance Median

$149

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: $38 (94%)

Insurance Median: $149 (369%)

Cash: $38 (94% of Medicare)

Ins. Median: $149 (369% 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 369% of the Medicare baseline (a markup of 269%). 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
Blue Cross Blue Shield	$43 - $133	106%
Kaiser Mcr Adv	$43	106%
Tricare	$43	106%
UnitedHealthcare	$43 - $150	106%
Ah Employee Health Plan - All Plans	$77	191%
Aetna	$122	302%
Healthnet Comm-All Other Plans	$126	312%
Kaiser-All Other Plans	$131	324%
Blue Shield Uc Care Members	$138	341%
Cigna	$147	364%
First Health-All Plans	$151	374%
Phcs-All Plans	$152	376%
Interplan-All Plans	$156	386%
Blue Shield-All Other Plans	$164	406%
Multiplan-All Plans	$164	406%
Healthnet Mcal	$173	428%
Kaiser Mcal	$173	428%
Medi-Cal	$173	428%
Ca Health And Wellness- All Plans	$215	532%
Celtic Mcaid-All Plans	$215	532%
Partnership Hp Mcal -All Plans	$285	705%

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 $38.
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 Adventist Health and Rideout 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.