CMS Price Transparency Data

Orthotic fitting and training

Facility: Alton Memorial Hospital

Billing Code: 97760 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97760
Insurance Median: $105
Cash Discount Price: $84
vs. Medicare Baseline: 2.28x Medicare

The contracted insurance negotiated median rate for a Orthotic fitting and training at Alton Memorial Hospital is $105. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $84. Compared to the federal Medicare reimbursement reference rate of $46.09, this hospital’s rate is 2.28x the Medicare baseline. Located in One Memorial Drive, Alton, IL.

Cash / Self-Pay

$84

Average discount available for prompt cash payment at this facility.

Insurance Median

$105

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: $84 (182%)

Insurance Median: $105 (228%)

Cash: $84 (182% of Medicare)

Ins. Median: $105 (228% 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 228% of the Medicare baseline (a markup of 128%). 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
Aetna	$44 - $332	95%
Blue Cross Blue Shield	$44 - $216	95%
Essence Healthcare [221]	$44	95%
Humana	$44 - $78	95%
UnitedHealthcare	$44 - $127	95%
Cox Health [757]	$46	100%
Devoted Health Plan [847]	$46	100%
Medica [662]	$46	100%
Healthlink [225]	$68 - $106	148%
Cox Health Systems Insurance Company [220]	$77 - $104	167%
Health Alliance [224]	$77	167%
Allied Benefits [498]	$81 - $332	176%
Hope Trust [806]	$81	176%
Med-Pay [480]	$91 - $105	197%
Unicare [568]	$91 - $106	197%
First Health Commercial [734]	$104	226%
Beechstreet [551]	$105	228%
Detego Health [868]	$105	228%
Health Systems Inc [620]	$105	228%
Healthcare Sol Mercy [609]	$105	228%
Multiplan Commercial [737]	$105	228%
Multiplan [240]	$105	228%
Phcs [244]	$105 - $112	228%
Preferred Health Professionals [561]	$106	230%
Cigna	$112 - $328	243%
Hfn [563]	$112	243%
Medica [661]	$112	243%
Healthscope Benefits [258]	$127	276%
Consociate [478]	$237	514%
Sarah Bush Lincoln [636]	$237	514%
Apwu Health Plan [216]	$328	712%
Nalc Health Benefit Plan [242]	$328	712%
Priority Health [648]	$328	712%
Coresource [497]	$332	720%
Fmh Benefit Service Inc [222]	$332	720%
Mail Handlers [495]	$332	720%

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 $84.
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 Alton Memorial 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.