CMS Price Transparency Data

Orthotic fitting and training

Facility: Monroe County Hospital

Billing Code: 97760 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97760
Insurance Median: $101
Cash Discount Price: $119
vs. Medicare Baseline: 2.19x Medicare

The contracted insurance negotiated median rate for a Orthotic fitting and training at Monroe County Hospital is $101. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $119. Compared to the federal Medicare reimbursement reference rate of $46.09, this hospital’s rate is 2.19x the Medicare baseline. Located in 6580 165Th Street, Albia, IA.

Cash / Self-Pay

$119

Average discount available for prompt cash payment at this facility.

Insurance Median

$101

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: $119 (258%)

Insurance Median: $101 (219%)

Cash: $119 (258% of Medicare)

Ins. Median: $101 (219% 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 219% of the Medicare baseline (a markup of 119%). 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
Mahp Mcare - All Plans	$83	180%
Tricare	$83	180%
UnitedHealthcare	$83 - $188	180%
Va Ccn - All Plans	$83	180%
Amerigroup Mcare	$84	182%
Humana	$84	182%
Wellmark Mcare	$84	182%
Aetna	$85 - $186	184%
Iowa Total Care Mcaid - All Plans	$99	215%
Molina Mcaid - All Plans	$100	217%
Amerigroup Mcaid - All Other Plans	$102	221%
Centivo - All Plans	$125	271%
Midlands Choice - All Plans	$139	302%
Preferred Hlth - All Plans	$148	321%
Geha - All Plans	$158	343%
Multiplan - All Plans	$178	386%
Integrated Hp - All Plans	$192	417%
Wellmark Hmo	$200	434%
Wellmark Ppo - All Other Plans	$216	469%

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 $119.
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 Monroe County 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.