CMS Price Transparency Data

Orthotic fitting and training

Facility: Warner Hospital and Health Services

Billing Code: 97760 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97760
Insurance Median: $126
Cash Discount Price: $152
vs. Medicare Baseline: 2.73x Medicare

The contracted insurance negotiated median rate for a Orthotic fitting and training at Warner Hospital and Health Services is $126. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $152. Compared to the federal Medicare reimbursement reference rate of $46.09, this hospital’s rate is 2.73x the Medicare baseline. Located in 422 W White St, Clinton, IL.

Cash / Self-Pay

$152

Average discount available for prompt cash payment at this facility.

Insurance Median

$126

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: $152 (330%)

Insurance Median: $126 (273%)

Cash: $152 (330% of Medicare)

Ins. Median: $126 (273% 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 273% of the Medicare baseline (a markup of 173%). 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	$59 - $152	128%
Aetna	$61 - $137	132%
Health Alliance Med Adv	$61 - $64	132%
Humana	$61 - $132	132%
Molina Mcr/Mcd Dual	$61 - $64	132%
UnitedHealthcare	$61 - $132	132%
Wellcare Mcr Adv-All Plans	$61 - $64	132%
Healthlink Hmo	$116 - $121	252%
City Of Clinton (Employees Serv)-All Plans	$119 - $124	258%
Cigna	$123 - $129	267%
Caterpillar-All Plans	$126 - $132	273%
Multiplan Phcs-All Plans	$126 - $132	273%
Health Alliance-All Other Plans	$131 - $137	284%
Healthlink Ppo/Work Comp-All Other Plans	$131 - $137	284%
Consociate Care Ppo-All Plans	$134 - $140	291%
Hfn Ppo/Epo-All Plans	$134 - $140	291%
Harmony Hp Mcaid-All Plans	$137	297%
Medicaid / KanCare	$137	297%
Meridian Hp-All Plans	$137	297%
Molina-All Other Plans	$137	297%
Three Rivers-All Plans	$141 - $147	306%

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 $152.
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 Warner Hospital and Health Services 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.