CMS Price Transparency Data

Orthotic fitting and training

Facility: Southcoast Hospitals Group

Billing Code: 97760 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97760
Insurance Median: $67
Cash Discount Price: $63
vs. Medicare Baseline: 1.45x Medicare

The contracted insurance negotiated median rate for a Orthotic fitting and training at Southcoast Hospitals Group is $67. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $63. Compared to the federal Medicare reimbursement reference rate of $46.09, this hospital’s rate is 1.45x the Medicare baseline. Located in 363 Highland Avenue, Fall River, MA.

Cash / Self-Pay

$63

Average discount available for prompt cash payment at this facility.

Insurance Median

$67

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: $63 (137%)

Insurance Median: $67 (145%)

Cash: $63 (137% of Medicare)

Ins. Median: $67 (145% 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
Wellsense Health Plan Clarity Connectorcare & Meta	$27	59%
Medicare (plans)	$31 - $63	67%
Aetna	$52 - $96	113%
Blue Cross Blue Shield	$52 - $204	113%
Evercare [1010304]	$52	113%
Tufts Senior Care Options [1010315]	$52	113%
UnitedHealthcare	$52 - $183	113%
Tufts [1010701]	$53	115%
Wellsense Health Plan Senior Care Options [1020208	$53	115%
Commonwealth Care Alliance [1080501]	$54	117%
Eternal Health [1010322]	$58	126%
Mass General Brigham Health Plan Commercial [10122	$71	154%
Mass General Brigham Health Plan Connectorcare [10	$71	154%
Fallon [1000114]	$73	158%
Group Insurance Service Center [1013001]	$76	165%
Innovative Health Plan [1025001]	$76	165%
Priority Health [1015001]	$76	165%
Wellsense Health Plan [1010202]	$78	169%
PHCS [1000125]	$82	178%
Cigna	$83	180%
Tufts Health Public Plans [1010213]	$90 - $412	195%
Wellpoint [1000102]	$93	202%
First Health [1000130]	$96	208%
Harvard Pilgrim [1010602]	$236	512%

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 $63.
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 Southcoast Hospitals Group 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.