CMS Price Transparency Data

Orthotic fitting and training

Facility: Southeast Iowa Regional Medical Center

Billing Code: 97760 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97760
Insurance Median: $534
Cash Discount Price: Unavailable
vs. Medicare Baseline: 11.59x Medicare

The contracted insurance negotiated median rate for a Orthotic fitting and training at Southeast Iowa Regional Medical Center is $534. 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 11.59x the Medicare baseline. Located in 1221 South Gear Avenue, West Burlington, IA.

Cash / Self-Pay

Unavailable

Average discount available for prompt cash payment at this facility.

Insurance Median

$534

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: $534 (1159%)

Ins. Median: $534 (1159% 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 1159% of the Medicare baseline (a markup of 1059%). 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	$20 - $23	43%
Aetna	$30 - $54	65%
American Healthplan Of Iowa - Midlevel	$37	80%
Immergrun	$38	82%
Plain Church	$39 - $1,280	85%
Humana	$46	100%
UnitedHealthcare	$46	100%
6 Degree	$48 - $1,575	104%
American Healthplan Of Iowa - Md	$48	104%
Absolute Solutions	$54 - $105	117%
First Agency	$54 - $105	117%
Multiplan	$54 - $105	117%
Henderson County	$57 - $111	124%
Midlands Choice	$59 - $1,772	128%
Blue Cross Blue Shield	$70 - $150	152%
Elap	$85 - $121	184%
Wellpoint (Amerigroup)	$121 - $1,103	263%
Immugrun	$136 - $1,240	295%
Brighton Amish Church	$140 - $1,280	304%
Geha	$201 - $1,831	436%

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 Southeast Iowa Regional Medical Center 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.