CMS Price Transparency Data

Orthotic fitting and training

Facility: UW Health

Billing Code: 97760 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97760
Insurance Median: $194
Cash Discount Price: $69
vs. Medicare Baseline: 4.21x Medicare

The contracted insurance negotiated median rate for a Orthotic fitting and training at UW Health is $194. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $69. Compared to the federal Medicare reimbursement reference rate of $46.09, this hospital’s rate is 4.21x the Medicare baseline. Located in 1401 East State Street, Rockford, IL.

Cash / Self-Pay

$69

Average discount available for prompt cash payment at this facility.

Insurance Median

$194

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: $69 (150%)

Insurance Median: $194 (421%)

Cash: $69 (150% of Medicare)

Ins. Median: $194 (421% 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 421% of the Medicare baseline (a markup of 321%). 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	$52 - $152	113%
Quartz Aso	$59	128%
Quartz Fully Insured	$59	128%
Aetna	$74 - $222	161%
Ecoh	$127 - $242	276%
Hfn	$127 - $242	276%
Alliance Premier Network	$137 - $168	297%
Medicare (plans)	$156 - $311	338%
The Alliance	$176 - $216	382%
UnitedHealthcare	$193 - $239	419%
Wps Ppo	$194 - $238	421%
Cigna	$200 - $245	434%
Beloit Healt System	$226 - $277	490%
Mercycare	$234 - $287	508%
First Health/Coventry	$246 - $302	534%
Health Payment Systems	$292 - $358	634%
Healthsmart	$292 - $358	634%
Sheboygan Employers Health Network	$312 - $382	677%
Multiplan	$349 - $427	757%

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 $69.
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 UW Health 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.