CMS Price Transparency Data

Orthotic fitting and training

Facility: Decatur Memorial Hospital

Billing Code: 97760 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97760
Insurance Median: $150
Cash Discount Price: $256
vs. Medicare Baseline: 3.25x Medicare

The contracted insurance negotiated median rate for a Orthotic fitting and training at Decatur Memorial Hospital is $150. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $256. Compared to the federal Medicare reimbursement reference rate of $46.09, this hospital’s rate is 3.25x the Medicare baseline. Located in 2300 North Edward Street, Decatur, IL.

Cash / Self-Pay

$256

Average discount available for prompt cash payment at this facility.

Insurance Median

$150

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: $256 (555%)

Insurance Median: $150 (325%)

Cash: $256 (555% of Medicare)

Ins. Median: $150 (325% 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 325% of the Medicare baseline (a markup of 225%). 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
Blue Cross Blue Shield	$40 - $262	87%
Aetna	$43 - $176	93%
Coventry	$43 - $157	93%
Health Alliance	$43 - $174	93%
Humana	$43 - $170	93%
Medicare (plans)	$43	93%
Tricare	$43 - $44	93%
UnitedHealthcare	$43 - $262	93%
Veterans Administration	$43	93%
Wellcare	$43	93%
Medicaid / KanCare	$45 - $46	98%
Illinois Workers Compensation	$52 - $139	113%
Caterpillar	$54	117%
Mennonite Churches	$108 - $113	234%
Plain Church Medical Group	$112 - $118	243%
Health Alliance Mh Employee Plan	$115 - $121	250%
Cigna	$116 - $122	252%
Hfn	$125 - $196	271%
Commercial Workers Compensation	$126 - $132	273%
6 Degrees Health	$150 - $157	325%
Hopetrust	$150 - $157	325%
Hst	$150 - $157	325%
Phcs Savility	$162 - $170	351%
Phcs Multiplan Ppo	$170 - $178	369%
Healthlink	$172 - $180	373%
Corvel	$180 - $189	391%
Consociate	$185 - $194	401%
Liability	$250 - $262	542%

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 $256.
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 Decatur 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.