CMS Price Transparency Data

Orthotic fitting and training

Facility: UMass Memorial Health - Harrington Hospital

Billing Code: 97760 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97760
Insurance Median: $169
Cash Discount Price: $225
vs. Medicare Baseline: 3.67x Medicare

The contracted insurance negotiated median rate for a Orthotic fitting and training at UMass Memorial Health - Harrington Hospital is $169. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $225. Compared to the federal Medicare reimbursement reference rate of $46.09, this hospital’s rate is 3.67x the Medicare baseline. Located in 100 South Street, Southbridge, MA.

Cash / Self-Pay

$225

Average discount available for prompt cash payment at this facility.

Insurance Median

$169

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: $225 (488%)

Insurance Median: $169 (367%)

Cash: $225 (488% of Medicare)

Ins. Median: $169 (367% 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 367% of the Medicare baseline (a markup of 267%). 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
Workers Compensation [20501]	$27	59%
Champva [11001]	$48	104%
Cigna	$48 - $175	104%
Institution [10406]	$48	104%
Mgb Mcr [10124]	$48	104%
Tufts Us Family [11203]	$48	104%
Aetna	$50 - $225	108%
Fallon Mcr Supp [20202]	$50	108%
Fallon Mcr [10105]	$50	108%
Tufts Mcr [10112]	$50	108%
UnitedHealthcare	$50 - $225	108%
Blue Cross Blue Shield	$51 - $243	111%
Commonwealth Care Alliance [10103]	$52	113%
Senior Whole Health [10110]	$53	115%
Wellpoint [11112]	$78	169%
Medicaid / KanCare	$117	254%
Hne [11108]	$146	317%
Tufts [11201]	$160	347%
First Health Network [11120]	$169	367%
Evernorth Behavioral Health [27]	$180	391%
Harvard Pilgrim [10701]	$202 - $242	438%
Connecticare [11105]	$225	488%
Fallon Carelon Hlth [28]	$225	488%
Fallon Mcaid Carelon Hlth [29]	$225	488%
Grants [20507]	$225	488%
Masshealth Mcd Mbhp [38]	$225	488%
Wellsense Mcaid Carelon Hlth [21]	$225	488%
Fallon Connectorcare [10503]	$290	629%
Hsno/Free Care [10801]	$681	1478%

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 $225.
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 Health - Harrington 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.