CMS Price Transparency Data

Orthotic fitting and training

Facility: Highland Hospital

Billing Code: 97760 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97760
Insurance Median: $39
Cash Discount Price: $99
vs. Medicare Baseline: 0.85x Medicare

The contracted insurance negotiated median rate for a Orthotic fitting and training at Highland Hospital is $39. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $99. Compared to the federal Medicare reimbursement reference rate of $46.09, this hospital’s rate is 0.85x the Medicare baseline. Located in 1000 South Avenue, Rochester, NY.

Cash / Self-Pay

$99

Average discount available for prompt cash payment at this facility.

Insurance Median

$39

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: $99 (215%)

Insurance Median: $39 (85%)

Cash: $99 (215% of Medicare)

Ins. Median: $39 (85% 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
Amerigroup (Bswny Alternate) [1720]	$12 - $103	26%
Excellus [2201]	$12 - $28	26%
Medicaid / KanCare	$12 - $103	26%
UnitedHealthcare	$12 - $103	26%
Martins Point [1205]	$22	48%
Medicare (plans)	$22 - $52	48%
Humana	$28	61%
Aetna	$29 - $67	63%
Molina Healthcare [5189], Molina Healthcare [1723]	$31 - $103	67%
Mvp [2900]	$38 - $97	82%
Fidelis [5155]	$103	223%
Cigna	$126	273%

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 $99.
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 Highland 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.