CMS Price Transparency Data

Orthotic fitting and training

Facility: Promedica Monroe Regional Hospital

Billing Code: 97760 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97760
Insurance Median: $70
Cash Discount Price: $83
vs. Medicare Baseline: 1.52x Medicare

The contracted insurance negotiated median rate for a Orthotic fitting and training at Promedica Monroe Regional Hospital is $70. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $83. Compared to the federal Medicare reimbursement reference rate of $46.09, this hospital’s rate is 1.52x the Medicare baseline. Located in 718 N Macomb St, Monroe, MI.

Cash / Self-Pay

$83

Average discount available for prompt cash payment at this facility.

Insurance Median

$70

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: $83 (180%)

Insurance Median: $70 (152%)

Cash: $83 (180% of Medicare)

Ins. Median: $70 (152% 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
Meridian	$23	50%
Priority Health	$23 - $70	50%
Aetna	$25 - $90	54%
Blue Cross Blue Shield	$25 - $125	54%
Molina Healthcare Of Michigan	$25	54%
UnitedHealthcare	$26 - $104	56%
Paramount Healthcare Inc	$42 - $97	91%
Health Alliance Plan	$43 - $105	93%
Humana	$44	95%
Veterans Affairs	$44	95%
Amerihealth	$59	128%
Frontpath	$74	161%
Encore Health Network	$90	195%
Health Ohio Network, Llc	$90	195%
Cofinity	$91	197%
Multiplan	$115	250%

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 $83.
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 Promedica Monroe Regional 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.