CMS Price Transparency Data

Prosthetic fitting and training

Facility: Loma Linda University Children's Hospital

Billing Code: 97761 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97761
Insurance Median: $146
Cash Discount Price: $94
vs. Medicare Baseline: 3.61x Medicare

The contracted insurance negotiated median rate for a Prosthetic fitting and training at Loma Linda University Children's Hospital is $146. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $94. Compared to the federal Medicare reimbursement reference rate of $40.41, this hospital’s rate is 3.61x the Medicare baseline. Located in 11234 Anderson Street Suite A, Loma Linda, CA.

Cash / Self-Pay

$94

Average discount available for prompt cash payment at this facility.

Insurance Median

$146

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: $94 (233%)

Insurance Median: $146 (361%)

Cash: $94 (233% of Medicare)

Ins. Median: $146 (361% 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 361% of the Medicare baseline (a markup of 261%). 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
Adventist Health	$42 - $85	104%
Lluh Dept Of Risk Management	$50	124%
Kaiser Foundation Hospitals	$79 - $139	195%
Epic Health Plan	$83	205%
Alpha Care Medical Group	$114 - $177	282%
Global Benefits Group	$125	309%
Temecula Valley Physicians Medical Group	$125	309%
Trivalley Medical Group	$125	309%
Cigna	$133 - $154	329%
Networks By Design	$135	334%
Aetna	$136	337%
Molina Healthcare Of Ca	$146	361%
Multiplan	$166	411%
Dignity Health	$177	438%
Galaxy Health	$177	438%
Prime Health Services	$177	438%
Vantage Medical Group	$177	438%
UnitedHealthcare	$206 - $417	510%
Blue Shield Of California	$279 - $421	690%
Blue Cross Blue Shield	$457	1131%

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 $94.
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 Loma Linda University Children's 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.