CMS Price Transparency Data

Orthotic fitting and training

Facility: Boston Children's Hospital

Billing Code: 97760 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97760
Insurance Median: $171
Cash Discount Price: $229
vs. Medicare Baseline: 3.71x Medicare

The contracted insurance negotiated median rate for a Orthotic fitting and training at Boston Children's Hospital is $171. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $229. Compared to the federal Medicare reimbursement reference rate of $46.09, this hospital’s rate is 3.71x the Medicare baseline. Located in 300 Longwood Avenue, Boston, MA.

Cash / Self-Pay

$229

Average discount available for prompt cash payment at this facility.

Insurance Median

$171

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: $229 (497%)

Insurance Median: $171 (371%)

Cash: $229 (497% of Medicare)

Ins. Median: $171 (371% 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 371% of the Medicare baseline (a markup of 271%). 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
Cdphp	$112 - $195	243%
Harvard Pilgrim	$116 - $155	252%
Unicare	$118	256%
Blue Cross Blue Shield	$129 - $174	280%
Aetna	$137 - $192	297%
United	$137 - $191	297%
Mgb/Allways	$139 - $169	302%
Tufts Public Plan	$141	306%
United Ri Nj Ny	$144	312%
Ambetter / Centene	$145	315%
Carelon Strategies/Bhs	$149	323%
UnitedHealthcare	$149 - $195	323%
Carelon/Beacon	$172	373%
Fallon	$175 - $177	380%
Health New England	$185	401%
Cigna	$195 - $207	423%
Ets/Lifetrac	$195	423%
Interlink Transplant	$195	423%
Community Health Options	$206	447%
Humana	$206	447%
Coventry/Hcvm/First Health	$211	458%
Multiplan/Phcs	$211 - $218	458%

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 $229.
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 Boston Children's 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.