CMS Price Transparency Data

Orthotic fitting and training

Facility: Pinckneyville Community Hospital

Billing Code: 97760 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97760
Insurance Median: $118
Cash Discount Price: $143
vs. Medicare Baseline: 2.56x Medicare

The contracted insurance negotiated median rate for a Orthotic fitting and training at Pinckneyville Community Hospital is $118. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $143. Compared to the federal Medicare reimbursement reference rate of $46.09, this hospital’s rate is 2.56x the Medicare baseline. Located in 5383 State Route 154, Pinckneyville, IL.

Cash / Self-Pay

$143

Average discount available for prompt cash payment at this facility.

Insurance Median

$118

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: $143 (310%)

Insurance Median: $118 (256%)

Cash: $143 (310% of Medicare)

Ins. Median: $118 (256% 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 256% of the Medicare baseline (a markup of 156%). 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
Humana	$53	115%
Umwa Mcr Adv - All Plans	$53	115%
UnitedHealthcare	$53 - $117	115%
Wellcare Mcr Adv - All Plans	$53	115%
Aetna	$54 - $197	117%
Blue Cross Blue Shield	$103 - $197	223%
Healthlink Hmo	$112	243%
Phcs - All Other Plans	$117	254%
Cigna	$118	256%
Healthlink Ppo - All Other Plans	$118	256%
Healthlink Work Comp	$118	256%
Phcs Savility	$122	265%
Multiplan - All Plans	$129	280%
Ambetter / Centene	$197	427%
Medicaid / KanCare	$197	427%

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 $143.
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 Pinckneyville Community 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.