CMS Price Transparency Data

Orthotic fitting and training

Facility: South Pointe Hospital

Billing Code: 97760 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97760
Insurance Median: $143
Cash Discount Price: $177
vs. Medicare Baseline: 3.10x Medicare

The contracted insurance negotiated median rate for a Orthotic fitting and training at South Pointe Hospital is $143. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $177. Compared to the federal Medicare reimbursement reference rate of $46.09, this hospital’s rate is 3.10x the Medicare baseline. Located in 20000 Harvard Road, Warrensville Heights, OH.

Cash / Self-Pay

$177

Average discount available for prompt cash payment at this facility.

Insurance Median

$143

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: $177 (384%)

Insurance Median: $143 (310%)

Cash: $177 (384% of Medicare)

Ins. Median: $143 (310% 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 310% of the Medicare baseline (a markup of 210%). 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	$60 - $273	130%
Humana	$60 - $232	130%
Summacare	$60 - $102	130%
The Health Plan	$60 - $164	130%
UnitedHealthcare	$60 - $169	130%
Upmc	$60 - $164	130%
Valor	$60	130%
United	$61 - $238	132%
Cigna	$62 - $218	135%
Perennial Health	$65	141%
Oscar	$82 - $105	178%
Paramount	$83	180%
Blue Cross Blue Shield	$85 - $218	184%
Buckeye	$85	184%
Molina	$85	184%
Caresource	$86	187%
Amerihealth	$89	193%
Cc Ehp	$109 - $111	236%
Aultcare	$117	254%
Ohcp	$133	289%
Omas	$136	295%
Mmo	$147 - $164	319%
Ohio Healthy	$147	319%
Healthsmart	$150	325%
Php	$164	356%
Gms	$191	414%
Medical Benefit Corp	$191	414%
Quality Care Partners	$191	414%
Consociate Health	$205	445%
Frontpath	$246	534%
Managed Care Services	$246	534%
Multiplan	$246	534%
Tertiary Care Network	$246	534%
Three Rivers	$246	534%

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 $177.
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 South Pointe 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.