CMS Price Transparency Data

Orthotic fitting and training

Facility: St Anthony Regional Hospital & Nursing Home

Billing Code: 97760 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97760
Insurance Median: $65
Cash Discount Price: $156
vs. Medicare Baseline: 1.41x Medicare

The contracted insurance negotiated median rate for a Orthotic fitting and training at St Anthony Regional Hospital & Nursing Home is $65. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $156. Compared to the federal Medicare reimbursement reference rate of $46.09, this hospital’s rate is 1.41x the Medicare baseline. Located in 311 South Clark Street, Carroll, IA.

Cash / Self-Pay

$156

Average discount available for prompt cash payment at this facility.

Insurance Median

$65

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: $156 (338%)

Insurance Median: $65 (141%)

Cash: $156 (338% of Medicare)

Ins. Median: $65 (141% 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.

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
Aetna	$56 - $140	122%
Humana	$56 - $133	122%
Medica Mcr - All Plans	$56	122%
UnitedHealthcare	$56 - $126	122%
Va Ccn - All Plans	$56	122%
Wellpoint Mcr Adv	$56	122%
Ia Total Care Mcr	$58	126%
Ia Total Care Mcaid	$64	139%
Wellpoint Mcaid - All Other Plans	$64	139%
Molina Mcaid - All Plans	$65	141%
Ia Total Care Comm - All Other Plans	$73	158%
Wellmark Hmo	$136	295%
Midlands Choice - All Plans	$147	319%
Wellmark Ppo-All Other Plans	$150	325%

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 $156.
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 St Anthony Regional Hospital & Nursing Home 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.