CMS Price Transparency Data

Orthotic fitting and training

Facility: Woodlawn Hospital

Billing Code: 97760 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97760
Insurance Median: $150
Cash Discount Price: $154
vs. Medicare Baseline: 3.25x Medicare

The contracted insurance negotiated median rate for a Orthotic fitting and training at Woodlawn Hospital is $150. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $154. Compared to the federal Medicare reimbursement reference rate of $46.09, this hospital’s rate is 3.25x the Medicare baseline. Located in 1400 E 9Th St, Rochester, IN.

Cash / Self-Pay

$154

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: $154 (334%)

Insurance Median: $150 (325%)

Cash: $154 (334% 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
Aetna	$45 - $195	98%
Blue Cross Blue Shield	$45 - $205	98%
Caresource Mcaid Hip	$45	98%
Caresource Mcr Adv	$45	98%
Humana	$45 - $159	98%
Mdwise Mcaid Excel Hip	$45	98%
Mhs Exch Mrktplce-All Other Plans	$45	98%
Mhs Mcaid Hip	$45	98%
UnitedHealthcare	$45 - $205	98%
Mhs Mcr Adv	$46	100%
Caresource Exch - All Other Plans	$59	128%
Ambetter / Centene	$60	130%
Partners Direct Health-All Plans	$139	302%
Cigna	$147 - $174	319%
Parkview Health Plans-All Plans	$154	334%
Sagamore All Other Grps - All Other Plans	$172	373%
Encore Comm-All Plans	$174	378%
Phcs/Multiplan-All Plans	$191	414%
Community Health Alliance-All Plans	$195	423%
Caresource Mcaid Hww	$205	445%
Mhs Mcaid Hcc	$205	445%
Mhs Mcaid Hhw	$205	445%

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 $154.
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 Woodlawn 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.