CMS Price Transparency Data

Orthotic fitting and training

Facility: Grossmont Hospital

Billing Code: 97760 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97760
Insurance Median: $120
Cash Discount Price: $159
vs. Medicare Baseline: 2.60x Medicare

The contracted insurance negotiated median rate for a Orthotic fitting and training at Grossmont Hospital is $120. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $159. Compared to the federal Medicare reimbursement reference rate of $46.09, this hospital’s rate is 2.60x the Medicare baseline. Located in 5555 Grossmont Center Drive Box 58, La Mesa, CA.

Cash / Self-Pay

$159

Average discount available for prompt cash payment at this facility.

Insurance Median

$120

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: $159 (345%)

Insurance Median: $120 (260%)

Cash: $159 (345% of Medicare)

Ins. Median: $120 (260% 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 260% of the Medicare baseline (a markup of 160%). 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	$32 - $139	69%
Multiplan	$32 - $144	69%
Community Health Group	$43 - $144	93%
UnitedHealthcare	$59 - $135	128%
Allianz Global Assistance	$63 - $135	137%
Blue Cross Blue Shield	$63 - $174	137%
Blue Shield	$63 - $170	137%
Cigna	$63 - $159	137%
County Medical Services	$63 - $191	137%
Epic Americas	$63 - $135	137%
Kaiser	$63 - $170	137%
Health Net	$83 - $208	180%
Managed Health Network	$89	193%
Indian Health Council	$98 - $170	213%
Medicare (plans)	$102	221%
Molina	$102 - $170	221%
San Diego Pace	$102 - $159	221%
California Health And Wellness	$159 - $191	345%

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 $159.
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 Grossmont Hospital 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.