CMS Price Transparency Data

Orthotic fitting and training

Facility: Hospital for Special Surgery

Billing Code: 97760 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97760
Insurance Median: $180
Cash Discount Price: $282
vs. Medicare Baseline: 3.91x Medicare

The contracted insurance negotiated median rate for a Orthotic fitting and training at Hospital for Special Surgery is $180. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $282. Compared to the federal Medicare reimbursement reference rate of $46.09, this hospital’s rate is 3.91x the Medicare baseline. Located in 535 East 70Th Street, New York, NY.

Cash / Self-Pay

$282

Average discount available for prompt cash payment at this facility.

Insurance Median

$180

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: $282 (612%)

Insurance Median: $180 (391%)

Cash: $282 (612% of Medicare)

Ins. Median: $180 (391% 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 391% of the Medicare baseline (a markup of 291%). 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
Blue Cross Blue Shield	$10 - $203	22%
Fidelis	$39 - $47	85%
Horizon	$46	100%
Emblem	$52 - $91	113%
UnitedHealthcare	$52 - $343	113%
Nyship	$59	128%
Aetna	$66 - $204	143%
Metro Plus	$74	161%
Affinity By Molina Health Plan [1005]	$77 - $169	167%
Connecticare [1039]	$77	167%
Emblem Health [1043]	$77 - $187	167%
Medicare (plans)	$77	167%
Cigna	$109 - $185	236%
Oxford [1096]	$169 - $218	367%
Christian Brothers [1034]	$173 - $204	375%
Meritain Health [1085]	$173 - $204	375%
Nippon Life [1092]	$173 - $204	375%
Webtpa [1356]	$173 - $204	375%
Apwu [1016]	$185	401%
Nalc [1090]	$185	401%
Qualcare [1101]	$185	401%
Wellfleet [1361]	$185	401%
Student Resources [1103]	$187 - $241	406%
Harvard Pilgrim [1057]	$213 - $275	462%
Fidelis Essential [1323]	$221 - $343	479%
Geha [1053]	$241	523%

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 $282.
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 Hospital for Special Surgery 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.