Orthotic fitting and training
Facility: Stormont Vail Hospital
Billing Code: 97760 (CPT)
- CPT Billing Code: 97760
- Insurance Median: $102
- Cash Discount Price: Unavailable
- vs. Medicare Baseline: 2.21x Medicare
Average discount available for prompt cash payment at this facility.
Median negotiated contract rate across all mapped commercial carriers.
Standard federal government reimbursement rate for this code.
Visual Cost Comparison vs. 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 221% of the Medicare baseline (a markup of 121%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.
Out-of-Pocket Cost Estimator
Estimate whether it is more economical to use your insurance or pay the upfront self-pay cash rate.
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 | $38 - $174 | 82% |
Consumer Guidance & Cost Commentary
For the CPT code 97760 (Orthotic fitting and training) at Stormont Vail Hospital in Topeka, KS, the facility's negotiated rate of $102.00 is significantly lower than the state average of $150.16, offering a potential savings of approximately 32% for patients with in-network coverage. However, it is important to note that commercial insurance rates often include administrative overhead and do not reflect the actual cost of care; in many cases, paying the cash price directly can be more economical for patients with high-deductible plans, as the cash rate may be lower than the insurance negotiated amount. Since the cash median is not available for this specific service, patients should contact the hospital directly to inquire about "self-pay" or "prompt-pay" discounts, which can further reduce the final bill by 20% to 50% if paid in full upfront.
When reviewing your bill, ensure you are comparing rates against the Medicare benchmark of $46.09 rather than the hospital's gross charge of $197.00, as the latter is inflated to make discounts appear larger. The facility's negotiated rate of $102.00 represents roughly 221% of the Medicare amount, which is within the typical range for commercial contracts, though fair pricing is often defined as 120% to 150% of Medicare. If you receive a balance bill for the difference between the provider's charge and your insurance payment, you may have protections under the No Surprises Act, particularly if the service was provided at an in-network facility. To avoid unexpected costs, always request a detailed, item