CMS Price Transparency Data

Orthotic fitting and training

Facility: Adventist Health Vallejo

Billing Code: 97760 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97760
Insurance Median: $112
Cash Discount Price: $29
vs. Medicare Baseline: 2.43x Medicare

The contracted insurance negotiated median rate for a Orthotic fitting and training at Adventist Health Vallejo is $112. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $29. Compared to the federal Medicare reimbursement reference rate of $46.09, this hospital’s rate is 2.43x the Medicare baseline. Located in 525 Oregon St, Vallejo, CA.

Cash / Self-Pay

$29

Average discount available for prompt cash payment at this facility.

Insurance Median

$112

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: $29 (63%)

Insurance Median: $112 (243%)

Cash: $29 (63% of Medicare)

Ins. Median: $112 (243% 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 243% of the Medicare baseline (a markup of 143%). 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 Non-Epn-All Other Plans	$31 - $294	67%
Aetna	$38 - $141	82%
Blue Shield Mcr Adv	$49	106%
Medicare (plans)	$49	106%
Napa County Mcal Child	$49	106%
Tricare	$49	106%
UnitedHealthcare	$49 - $173	106%
Va Mcr-All Other Plans	$49	106%
Blue Cross Blue Shield	$53 - $441	115%
Ah Employee Health Plan-All Plans	$54 - $88	117%
Interplan-All Plans	$58 - $177	126%
Kaiser-All Plans	$58 - $228	126%
Cigna	$62 - $218	135%
Phcs-All Plans	$62 - $150	135%
Western Growers-All Plans	$70 - $297	152%
Health Management Network-All Plans	$95 - $231	206%
Three Rivers-All Plans	$101 - $245	219%
Medi-Cal	$112 - $272	243%
Blue Shield Behav Hlth	$122	265%
Healthnet-All Plans	$167	362%
Choicecare-All Plans	$190	412%
Beech Street-All Plans	$204	443%
Galaxy Network-All Plans	$245	532%
Va Medi-Cal	$272	590%
Blue Shield Epn	$286	621%

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 $29.
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 Vallejo 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.