CMS Price Transparency Data

Prosthetic fitting and training

Facility: Adventist Health Vallejo

Billing Code: 97761 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97761
Insurance Median: $157
Cash Discount Price: $37
vs. Medicare Baseline: 3.89x Medicare

The contracted insurance negotiated median rate for a Prosthetic fitting and training at Adventist Health Vallejo is $157. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $37. Compared to the federal Medicare reimbursement reference rate of $40.41, this hospital’s rate is 3.89x the Medicare baseline. Located in 525 Oregon St, Vallejo, CA.

Cash / Self-Pay

$37

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: $37 (92%)

Insurance Median: $157 (389%)

Cash: $37 (92% 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 Mcr Adv	$43	106%
Medicare (plans)	$43	106%
Napa County Mcal Child	$43	106%
Tricare	$43	106%
UnitedHealthcare	$43 - $157	106%
Va Mcr-All Other Plans	$43	106%
Ah Employee Health Plan-All Plans	$77	191%
Blue Shield Behav Hlth	$111	275%
Aetna	$128	317%
Phcs-All Plans	$135	334%
Healthnet-All Plans	$151	374%
Interplan-All Plans	$160	396%
Choicecare-All Plans	$172	426%
Beech Street-All Plans	$184	455%
Cigna	$197	488%
Kaiser-All Plans	$207	512%
Health Management Network-All Plans	$209	517%
Galaxy Network-All Plans	$221	547%
Three Rivers-All Plans	$221	547%
Medi-Cal	$246	609%
Va Medi-Cal	$246	609%
Blue Shield Epn	$286	708%
Blue Shield Non-Epn-All Other Plans	$294	728%
Western Growers-All Plans	$297	735%
Blue Cross Blue Shield	$369 - $441	913%

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 $37.
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 Vallejo 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.