CMS Price Transparency Data

Orthotic fitting and training

Facility: Essentia Health Virginia

Billing Code: 97760 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97760
Insurance Median: $51
Cash Discount Price: $72
vs. Medicare Baseline: 1.11x Medicare

The contracted insurance negotiated median rate for a Orthotic fitting and training at Essentia Health Virginia is $51. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $72. Compared to the federal Medicare reimbursement reference rate of $46.09, this hospital’s rate is 1.11x the Medicare baseline. Located in 901 9Th Street North, Virginia, MN.

Cash / Self-Pay

$72

Average discount available for prompt cash payment at this facility.

Insurance Median

$51

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: $72 (156%)

Insurance Median: $51 (111%)

Cash: $72 (156% of Medicare)

Ins. Median: $51 (111% 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
Medica Access	$26	56%
Healthpartners Care Pmap	$45	98%
Advocare/Security Health	$46	100%
Blue Cross Blue Shield	$46 - $87	100%
Freedom Blue Ppo	$46	100%
Healthpartners Care Msho / Mcr Adv	$46	100%
Imcare Msho Pcc Prime	$46	100%
Imcare Msho Ref Req	$46	100%
Itasca Med Care	$46	100%
Medica Advantage Solutions	$46	100%
Medica Msho/Dual Solutions	$46	100%
Medica Prime Solution Group	$46	100%
Medicare (plans)	$46	100%
Nd Va Administration	$46	100%
Platinum Blue/Vantage Blue	$46	100%
Primewest Msho	$46	100%
Secure Blue Msho	$46	100%
Ubh Cost Plan	$46	100%
Ubh Msho	$46	100%
Ucare Msho	$46	100%
UnitedHealthcare	$46 - $100	100%
Primewest	$48	104%
Sanford Healthplan	$49 - $97	106%
Blue Plus Pmap Pcc Prime	$54	117%
Medica	$73 - $81	158%
Medica Uplan	$73	158%
Ucare	$75	163%
Healthpartners	$81 - $103	176%
Wea	$82 - $88	178%
Medica Choice	$83	180%
America'S Ppo	$88	191%
Security Health	$88	191%
Wps	$96	208%
Aetna	$97	210%
Cigna	$103	223%
Healthpartners Pcc Prime	$103	223%

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 $72.
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 Essentia Health Virginia 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.