CMS Price Transparency Data

Prosthetic fitting and training

Facility: Adventist Health Clearlake

Billing Code: 97761 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97761
Insurance Median: $193
Cash Discount Price: $82
vs. Medicare Baseline: 4.78x Medicare

The contracted insurance negotiated median rate for a Prosthetic fitting and training at Adventist Health Clearlake is $193. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $82. Compared to the federal Medicare reimbursement reference rate of $40.41, this hospital’s rate is 4.78x the Medicare baseline. Located in 15630 18Th Ave - Hwy 53, Clearlake, CA.

Cash / Self-Pay

$82

Average discount available for prompt cash payment at this facility.

Insurance Median

$193

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: $82 (203%)

Insurance Median: $193 (478%)

Cash: $82 (203% of Medicare)

Ins. Median: $193 (478% 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 478% of the Medicare baseline (a markup of 378%). 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 Mcr Adv	$48	119%
Kaiser Mcr Adv	$48	119%
Tricare	$48	119%
Blue Cross Blue Shield	$50 - $543	124%
UnitedHealthcare	$52 - $189	129%
Ah Employee Health Plan - All Plans	$95	235%
Aetna	$170	421%
Western Growers- All Plans	$170	421%
First Health- All Plans	$182	450%
Healthnet- All Plans	$186	460%
Foundation- All Plans	$193	478%
Health Mgmt Network- All Plans	$193	478%
Humana	$193	478%
Phcs- All Plans	$193	478%
Cigna	$204	505%
Interplan- All Plans	$204	505%
Kaiser- All Other Plans	$204	505%
Three Rivers Provider Network- All Plans	$204	505%
Bc Managed Mcal	$227	562%
Medi-Cal	$227	562%
Blue Shield Epn - All Other Plans	$326	807%
Blue Shield Non-Epn	$333	824%
Partnership Mcal - All Plans	$375	928%

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 $82.
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 Clearlake 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.