CMS Price Transparency Data

Orthotic fitting and training

Facility: Piedmont Mountainside Hospital Inc

Billing Code: 97760 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97760
Insurance Median: $200
Cash Discount Price: $80
vs. Medicare Baseline: 4.34x Medicare

The contracted insurance negotiated median rate for a Orthotic fitting and training at Piedmont Mountainside Hospital Inc is $200. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $80. Compared to the federal Medicare reimbursement reference rate of $46.09, this hospital’s rate is 4.34x the Medicare baseline. Located in 1266 Highway 515 South, Jasper, GA.

Cash / Self-Pay

$80

Average discount available for prompt cash payment at this facility.

Insurance Median

$200

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: $80 (174%)

Insurance Median: $200 (434%)

Cash: $80 (174% of Medicare)

Ins. Median: $200 (434% 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 434% of the Medicare baseline (a markup of 334%). 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
Medicaid / KanCare	$29 - $30	63%
Blue Cross Blue Shield	$118 - $124	256%
First Health [10303]	$187	406%
Aetna	$190	412%
Novanet [10819]	$200	434%
Beechstreet [10800]	$214	464%
Phcs [10601]	$214	464%
UnitedHealthcare	$215 - $267	466%
Kaiser [10500]	$227	493%
Multiplan [10600]	$227	493%
Alliant Health Plans Of Georgia [10952]	$267	579%

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 $80.
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 Piedmont Mountainside Hospital Inc 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.