CMS Price Transparency Data

Prosthetic fitting and training

Facility: City of Hope National Medical Center

Billing Code: 97761 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97761
Insurance Median: $159
Cash Discount Price: $181
vs. Medicare Baseline: 3.93x Medicare

The contracted insurance negotiated median rate for a Prosthetic fitting and training at City of Hope National Medical Center is $159. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $181. Compared to the federal Medicare reimbursement reference rate of $40.41, this hospital’s rate is 3.93x the Medicare baseline. Located in 1500 Duarte Rd, Duarte, CA.

Cash / Self-Pay

$181

Average discount available for prompt cash payment at this facility.

Insurance Median

$159

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: $181 (448%)

Insurance Median: $159 (393%)

Cash: $181 (448% of Medicare)

Ins. Median: $159 (393% 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 393% of the Medicare baseline (a markup of 293%). 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
Health Net	$37 - $229	92%
Cal Optima	$46	114%
Heritage Provider Network	$57 - $136	141%
Inland Empire	$57 - $156	141%
Prime Healthcare Keenan	$80 - $187	198%
Blue Cross Blue Shield	$83 - $345	205%
UnitedHealthcare	$93 - $390	230%
Blue Shield	$98 - $390	243%
Blue Shield Promise	$116 - $136	287%
Cencal	$133 - $156	329%
La Care Health	$133 - $156	329%
Kaiser	$149 - $176	369%
Aetna	$166 - $195	411%
Gold Coast	$166 - $195	411%
Molina	$166 - $254	411%
Cigna	$178 - $209	440%
Facey	$183 - $214	453%
Healthcare Partners	$193 - $226	478%
St. Joseph Heritage	$199 - $234	492%
Primecare Medical Network	$216 - $254	535%
Blue Shield Covca	$238	589%
First Health	$256 - $300	634%
Phcs Multiplan	$299 - $351	740%

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 $181.
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 City of Hope National 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.