CMS Price Transparency Data

Orthotic fitting and training

Facility: Queens Hospital Center

Billing Code: 97760 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97760
Insurance Median: $115
Cash Discount Price: $61
vs. Medicare Baseline: 2.50x Medicare

The contracted insurance negotiated median rate for a Orthotic fitting and training at Queens Hospital Center is $115. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $61. Compared to the federal Medicare reimbursement reference rate of $46.09, this hospital’s rate is 2.50x the Medicare baseline. Located in 82-68 164Th Street, Jamaica, NY.

Cash / Self-Pay

$61

Average discount available for prompt cash payment at this facility.

Insurance Median

$115

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: $61 (132%)

Insurance Median: $115 (250%)

Cash: $61 (132% of Medicare)

Ins. Median: $115 (250% 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 250% of the Medicare baseline (a markup of 150%). 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
Aetna	$23 - $257	50%
Healthfirst	$26 - $258	56%
Local 1199	$33 - $115	72%
Affinity	$47 - $258	102%
Blue Cross Blue Shield	$53 - $258	115%
Centerlight	$53 - $149	115%
Elderplan	$53 - $194	115%
Fidelis	$53 - $258	115%
Wellcare	$54 - $57	117%
Centers Plan For Healthy Living	$55	119%
Hamaspik	$56	122%
Oscar	$66 - $614	143%
Metroplus	$107 - $258	232%
Amidacare	$115	250%
Carelon	$115 - $194	250%
Senior Whole Health	$115	250%
United	$115 - $504	250%
United Behavioral Health	$115 - $126	250%
Carelon (Amida Care)	$117	254%
Vnsny	$117 - $254	254%
Emblem	$172 - $319	373%
Multiplan	$239	519%
Villagecare Max	$254	551%
Magnacare	$320	694%
Oxford	$362 - $410	785%

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 $61.
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 Queens Hospital Center 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.