CMS Price Transparency Data

Orthotic fitting and training

Facility: Margaretville Memorial Hospital

Billing Code: 97760 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97760
Insurance Median: $141
Cash Discount Price: $200
vs. Medicare Baseline: 3.06x Medicare

The contracted insurance negotiated median rate for a Orthotic fitting and training at Margaretville Memorial Hospital is $141. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $200. Compared to the federal Medicare reimbursement reference rate of $46.09, this hospital’s rate is 3.06x the Medicare baseline. Located in 42084 State Highway 28, Margaretville, NY.

Cash / Self-Pay

$200

Average discount available for prompt cash payment at this facility.

Insurance Median

$141

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: $200 (434%)

Insurance Median: $141 (306%)

Cash: $200 (434% of Medicare)

Ins. Median: $141 (306% 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 306% of the Medicare baseline (a markup of 206%). 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
Mvp Gold (McR)	$88 - $94	191%
Blue Cross Blue Shield	$88 - $230	191%
Hamaspik (McR)	$88 - $94	191%
Medicare (plans)	$88 - $141	191%
Aetna	$88 - $210	191%
UnitedHealthcare	$88 - $176	191%
Affinity By Molina McR	$92 - $99	200%
Cdphp	$97 - $104	210%
Magnacare Standard	$140 - $150	304%
Todays Options	$145 - $155	315%
Oxford	$147 - $165	319%
Self-Pay	$153 - $164	332%
Emblem Select Care (Exchange)	$154	334%
Emblem Ghi/Hip Ppo/Cbp	$156	338%
Oxford Exchange	$158	343%
Multiplan	$164 - $175	356%
First Health	$180 - $193	391%
Emblem Ghi/Hip Hmo/Epo/Pos	$181	393%
Mvp	$199	432%
Emblem	$230 - $270	499%
Mvp Exchange	$238	516%
Mvp Hmo/Ppo	$280	608%
Magnacare	$390	846%
Magnacare Preferred	$413	896%

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 $200.
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 Margaretville Memorial 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.