CMS Price Transparency Data

Prosthetic fitting and training

Facility: Adventist Health Reedley

Billing Code: 97761 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97761
Insurance Median: $159
Cash Discount Price: $48
vs. Medicare Baseline: 3.93x Medicare

The contracted insurance negotiated median rate for a Prosthetic fitting and training at Adventist Health Reedley is $159. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $48. Compared to the federal Medicare reimbursement reference rate of $40.41, this hospital’s rate is 3.93x the Medicare baseline. Located in 372 W Cypress Ave, Reedley, CA.

Cash / Self-Pay

$48

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: $48 (119%)

Insurance Median: $159 (393%)

Cash: $48 (119% 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
Blue Shield Mcare	$43	106%
Dignity Mcr Adv Op/Profee Only	$43	106%
Fhcn Pace Mcr Adv-All Plans	$43	106%
Healthnet- Mcr Adv	$43	106%
Kaiser Mcr Adv	$43	106%
Phs Prime Health Srvcs	$43	106%
Tricare	$43	106%
UnitedHealthcare	$43 - $301	106%
Bright Health Mcr Adv - All Plans	$67	166%
Aetna	$71 - $390	176%
Ah Employee Health Plan - All Plans	$77	191%
Healthnet- All Other Plans	$110	272%
Western Growers/Pinnacle- All Plans	$117	290%
Kaiser - All Other Plans	$127	314%
Blue Shield Epn - All Other Plans	$138	341%
Blue Shield Non Epn	$159	393%
Cigna	$165	408%
Physicians Med Group Op/Profee Only- All Plans	$203	502%
Cal Viva Hlth Mcal - All Plans	$254	629%
Kern Health Systems Mcal-All Plans	$254	629%
Medi-Cal	$254	629%
Dignity Mcal Op/Profee Only-All Other Plans	$279	690%
Healthnet Medi-Cal	$303	750%
Community Care Ipa Mcal-All Plans	$330	817%
Blue Cross Blue Shield	$393 - $526	973%

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 $48.
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 Reedley 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.