CMS Price Transparency Data

Orthotic fitting and training

Facility: Adventist Health St Helena

Billing Code: 97760 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97760
Insurance Median: $129
Cash Discount Price: $32
vs. Medicare Baseline: 2.80x Medicare

The contracted insurance negotiated median rate for a Orthotic fitting and training at Adventist Health St Helena is $129. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $32. Compared to the federal Medicare reimbursement reference rate of $46.09, this hospital’s rate is 2.80x the Medicare baseline. Located in 10 Woodland Road, Saint Helena, CA.

Cash / Self-Pay

$32

Average discount available for prompt cash payment at this facility.

Insurance Median

$129

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$46.09

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $46.09 (100%)

Cash / Self-Pay: $32 (69%)

Insurance Median: $129 (280%)

Cash: $32 (69% of Medicare)

Ins. Median: $129 (280% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $46.09 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 280% of the Medicare baseline (a markup of 180%). 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	$38 - $151	82%
Blue Shield Epn-All Other Plans	$50 - $286	108%
UnitedHealthcare	$51 - $186	111%
Blue Cross Blue Shield	$53 - $447	115%
Blue Shield Non-Epn	$53 - $294	115%
Blue Shield Bh Mcr Adv	$56	122%
Blue Shield Mcr Adv	$56	122%
Kaiser Mcr Adv	$56	122%
Tricare	$56	122%
Va Mcr - All Other Plans	$56	122%
Ah Employee Health Plan - All Plans	$62 - $101	135%
Cigna	$62 - $233	135%
Interplan-All Plans	$67 - $189	145%
Kaiser-All Other Plans	$67 - $239	145%
Phcs-All Plans	$77 - $160	167%
Western Growers-All Plans	$80 - $297	174%
Health Management Network-All Plans	$119 - $247	258%
Three Rivers-All Plans	$126 - $262	273%
Blue Shield Behav Hlth	$131	284%
Medi-Cal	$140	304%
Healthnet-All Plans	$178	386%
Choicecare-All Plans	$204	443%
Beech Street-All Plans	$218	473%
Galaxy Network-All Plans	$262	568%
Va Medi-Cal	$291	631%

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 $32.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 97760.

Insurance In-Network Protection Plan

Contact your insurance company to confirm Adventist Health St Helena is fully in-network.
Ask your insurer if "Prior Authorization" is required for CPT code 97760.
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.