CMS Price Transparency Data

Orthotic fitting and training

Facility: UMass Memorial Healthalliance Hospitals

Billing Code: 97760 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97760
Insurance Median: $86
Cash Discount Price: $169
vs. Medicare Baseline: 1.87x Medicare

The contracted insurance negotiated median rate for a Orthotic fitting and training at UMass Memorial Healthalliance Hospitals is $86. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $169. Compared to the federal Medicare reimbursement reference rate of $46.09, this hospital’s rate is 1.87x the Medicare baseline. Located in 60 Hospital Road, Leominster, MA.

Cash / Self-Pay

$169

Average discount available for prompt cash payment at this facility.

Insurance Median

$86

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: $169 (367%)

Insurance Median: $86 (187%)

Cash: $169 (367% of Medicare)

Ins. Median: $86 (187% 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
Workers Compensation [20501]	$27	59%
Champva [11001]	$48	104%
Cigna	$48 - $145	104%
Correctional Care [11003]	$48 - $76	104%
Institution [10406]	$48 - $90	104%
Medicare (plans)	$48	104%
Tufts Dual [10111]	$48	104%
Tufts Us Family [11203]	$48	104%
Aetna	$50 - $111	108%
Fallon Mcr Supp [20202]	$50	108%
Tufts Mcr [10112]	$50	108%
UnitedHealthcare	$50 - $169	108%
Blue Cross Blue Shield	$51 - $249	111%
Commonwealth Care Mcr [10115]	$52	113%
Harvard Pilgrim Mcr [10106]	$52	113%
Mgb Mcr [10124]	$52	113%
Senior Whole Health [10110]	$53	115%
Wellpoint [11112]	$78	169%
Medicaid / KanCare	$88 - $97	191%
Hne [11108]	$94	204%
First Health Network [11120]	$127	276%
Multiplan [11109]	$127	276%
Tufts [11201]	$132	286%
Connecticare [11105]	$169	367%
Fallon Carelon Hlth [28]	$169	367%
Fallon Mcaid Carelon Hlth [29]	$169	367%
Grants [20507]	$169	367%
Harvard Pilgrim [10701]	$185 - $222	401%
Fallon Connectorcare [10503]	$290	629%
Hsno/Free Care [10801]	$294	638%

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 $169.
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 UMass Memorial Healthalliance Hospitals 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.