CMS Price Transparency Data

Orthotic fitting and training

Facility: Southwest General Health Center

Billing Code: 97760 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97760
Insurance Median: $80
Cash Discount Price: $131
vs. Medicare Baseline: 1.74x Medicare

The contracted insurance negotiated median rate for a Orthotic fitting and training at Southwest General Health Center is $80. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $131. Compared to the federal Medicare reimbursement reference rate of $46.09, this hospital’s rate is 1.74x the Medicare baseline. Located in 18697 Bagley Road, Middleburg Heights, OH.

Cash / Self-Pay

$131

Average discount available for prompt cash payment at this facility.

Insurance Median

$80

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: $131 (284%)

Insurance Median: $80 (174%)

Cash: $131 (284% of Medicare)

Ins. Median: $80 (174% 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
Medical Mutual	$26 - $29	56%
Medical Mutual-Ohio	$26 - $60	56%
Tptn	$27	59%
Buckeye	$34 - $116	74%
Caresource	$34 - $116	74%
Humana	$34 - $116	74%
Molina	$34 - $116	74%
UnitedHealthcare	$34 - $116	74%
Amerihealth Caritas	$36 - $116	78%
Healthsmart	$53 - $59	115%
Blue Cross Blue Shield	$60 - $116	130%
Valor Health	$60	130%
Health Design Plus	$61 - $68	132%
Clarity Health	$66 - $74	143%
Healthspan	$66 - $74	143%
Healthsmart Preferred	$75 - $83	163%
Ohio Health Choice Plus	$80 - $89	174%
Aetna	$90 - $100	195%
Summacare	$90 - $99	195%
Coventry	$115 - $127	250%
First Health	$115 - $127	250%
Ohio Health Choice	$128 - $142	278%
Private Healthare Systems	$133 - $147	289%
Cigna	$184	399%

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 $131.
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 Southwest General Health 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.