CMS Price Transparency Data

Prosthetic fitting and training

Facility: Adventist Health Tulare

Billing Code: 97761 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97761
Insurance Median: $157
Cash Discount Price: $48
vs. Medicare Baseline: 3.89x Medicare

The contracted insurance negotiated median rate for a Prosthetic fitting and training at Adventist Health Tulare is $157. 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 3.89x the Medicare baseline. Located in 869 North Cherry Street, Tulare, CA.

Cash / Self-Pay

$48

Average discount available for prompt cash payment at this facility.

Insurance Median

$157

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: $157 (389%)

Cash: $48 (119% of Medicare)

Ins. Median: $157 (389% 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 389% of the Medicare baseline (a markup of 289%). 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 Op Only - All Other Plans	$43	106%
Fhcn Pace Mcr Adv - All Plans	$43	106%
Medicare (plans)	$43	106%
Prime Health - All Plans	$43	106%
Tricare	$43	106%
UnitedHealthcare	$43 - $602	106%
Prison Hlthcre - All Plans	$55	136%
Cal Forensic Med Grp - All Plans	$56	139%
Bright Health - All Plans	$62	153%
Ah Employee Health Plan - All Plans	$77	191%
Incentive Hlth - All Plans	$77	191%
Healthnet Hmo/Ppo - All Other Plans	$114	282%
Cigna	$118	292%
Western Growers - All Plans	$119	294%
Aetna	$149	369%
Network By Design-All Plans	$165	408%
Hs Interplan-All Plans	$170	421%
Multiplan - All Plans	$216	535%
Medi-Cal	$254	629%
Blue Shield Epn	$256	634%
Dignity Mcal Op Only	$279	690%
Independence Op Only - All Plans	$279	690%
Ccipa Medi-Cal - All Plans	$330	817%
Healthnet Medi-Cal	$333	824%
Blue Shield-All Other Plans	$356	881%
Blue Cross Blue Shield	$365 - $410	903%

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 Tulare 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.