CMS Price Transparency Data

Orthotic fitting and training

Facility: Valley Children's Hospital

Billing Code: 97760 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97760
Insurance Median: $213
Cash Discount Price: Unavailable
vs. Medicare Baseline: 4.62x Medicare

The contracted insurance negotiated median rate for a Orthotic fitting and training at Valley Children's Hospital is $213. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is unavailable. Compared to the federal Medicare reimbursement reference rate of $46.09, this hospital’s rate is 4.62x the Medicare baseline. Located in 9300 Valley Childrens Place, Madera, CA.

Cash / Self-Pay

Unavailable

Average discount available for prompt cash payment at this facility.

Insurance Median

$213

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%)

Insurance Median: $213 (462%)

Ins. Median: $213 (462% 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 462% of the Medicare baseline (a markup of 362%). 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
Health Net	$115 - $213	250%
Dignity Health Central Coast	$162	351%
Allcare Ipa	$163	354%
Central Valley Medical Providers Ipa	$163	354%
United Physicians Network Ipa	$163	354%
Community Health	$179	388%
Stanislaus Partners In Health	$179	388%
Physicians Choice Medical Group	$183	397%
Health Plan Of San Joaquin	$196	425%
Fowler Packing	$202	438%
Dignity (Formerly Managed Care Systems)	$205	445%
Kaiser	$212	460%
Kern Legacy	$212	460%
Aetna	$218	473%
Blue Shield	$218 - $247	473%
UnitedHealthcare	$218 - $232	473%
First Health Formerly Coventry	$241	523%
Bakersfield Family Medical Group	$244	529%
Network By Design	$253	549%
Community Care Health Plan	$261	566%
Health Smart	$261	566%
Key Medical Ipa	$261	566%
Sutter Health	$277	601%
Multiplan	$312	677%
Blue Cross Blue Shield	$719	1560%

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 $X.
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 Valley Children's 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.