CMS Price Transparency Data

Orthotic fitting and training

Facility: Monroe Hospital

Billing Code: 97760 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97760
Insurance Median: $60
Cash Discount Price: $43
vs. Medicare Baseline: 1.30x Medicare

The contracted insurance negotiated median rate for a Orthotic fitting and training at Monroe Hospital is $60. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $43. Compared to the federal Medicare reimbursement reference rate of $46.09, this hospital’s rate is 1.30x the Medicare baseline. Located in 4011 S Monroe Medical Park Blvd, Bloomington, IN.

Cash / Self-Pay

$43

Average discount available for prompt cash payment at this facility.

Insurance Median

$60

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: $43 (93%)

Insurance Median: $60 (130%)

Cash: $43 (93% of Medicare)

Ins. Median: $60 (130% 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.

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	95%
Blue Cross Blue Shield	$44 - $82	95%
Care Source	$44 - $82	95%
Medicare (plans)	$44	95%
Tricare	$44	95%
UnitedHealthcare	$44 - $82	95%
Usa Senior Care Network	$44	95%
Worthington Christian Fellowship	$44	95%
Monroe Medical Group And Managed Health Services	$45 - $82	98%
Provider Partners Health Plan	$48	104%
Americas Choice Provider Network Acpn	$60 - $82	130%
Corvel Workers Compensation	$60 - $76	130%
Employer Direct Healthcare	$60 - $61	130%
Encore Health Network Workers Compensation	$60 - $82	130%
Medicaid / KanCare	$60 - $82	130%
Multiplan	$60 - $82	130%
Prime Health Services	$60 - $82	130%
Provider Network Of America	$60 - $82	130%
Provider Select	$60 - $82	130%
Three Rivers	$60 - $82	130%
Workers Compensation	$60 - $82	130%
Zelis Healthcare Fka Stratose	$60 - $82	130%

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 $43.
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 Monroe 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.