CMS Price Transparency Data

Prosthetic fitting and training

Facility: Adventist Health Sonora

Billing Code: 97761 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97761
Insurance Median: $123
Cash Discount Price: $24
vs. Medicare Baseline: 3.04x Medicare

The contracted insurance negotiated median rate for a Prosthetic fitting and training at Adventist Health Sonora is $123. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $24. Compared to the federal Medicare reimbursement reference rate of $40.41, this hospital’s rate is 3.04x the Medicare baseline. Located in 1000 Greenley Road, Sonora, CA.

Cash / Self-Pay

$24

Average discount available for prompt cash payment at this facility.

Insurance Median

$123

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: $24 (59%)

Insurance Median: $123 (304%)

Cash: $24 (59% of Medicare)

Ins. Median: $123 (304% 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 304% of the Medicare baseline (a markup of 204%). 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
Aetna	$43 - $99	106%
Blue Shield Mcare	$43	106%
Healthnet Mcr Adv	$43	106%
Phs Prime Health Srvcs-All Plans	$43	106%
Tricare	$43	106%
UnitedHealthcare	$43 - $122	106%
Kaiser - All Plans	$71	176%
Ah Employee Health Plan - All Plans	$77	191%
Blue Shield - All Other Plans	$108	267%
Blue Shield Epn	$108	267%
Trpn - Three Rivers Ppo - All Plans	$114	282%
Beech Street- All Plans	$121	299%
Greatwest Oa/Pos/Hmo	$121	299%
Healthnet - All Other Plans	$124	307%
Affordable Health - All Plans	$128	317%
Greatwest Ppo - All Other Plans	$128	317%
Interplan - All Plans	$128	317%
Multiplan - All Plans	$128	317%
Phcs Ppo - All Plans	$128	317%
Cigna	$135	334%
Stanilaus Foundation - All Plans	$135	334%
Medi-Cal	$142	351%
Central Ca Alliance Ccs Mcal	$161	398%
Central Ca Alliance Chdp Mcal	$161	398%
Central Ca Alliance Mcal	$161	398%
Celtic Ca Hlth Well Mcal - All Plans	$196	485%
Healthnet Mcal	$211	522%
Western Growers/Pinnacle - All Plans	$342	846%
Bc Exchange	$365	903%
Bc Non-Mcs - All Other Plans	$409	1012%
Bc Mcs	$492	1218%

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 $24.
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 Sonora 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.