Orthotic fitting and training
Facility: Lmh
Billing Code: 97760 (CPT)
- CPT Billing Code: 97760
- Insurance Median: $54
- Cash Discount Price: $51
- vs. Medicare Baseline: 1.17x 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.
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 |
|---|---|---|
| Allwell | $39 - $44 | 85% |
| Blue Cross Blue Shield | $40 - $131 | 87% |
| UnitedHealthcare | $40 - $185 | 87% |
| Haskell Indian Health Services | $43 | 93% |
| Medicare (plans) | $43 | 93% |
| Cigna | $43 - $135 | 93% |
| Humana | $43 | 93% |
| Ambetter / Centene | $57 - $67 | 124% |
| Aetna | $129 - $168 | 280% |
| Non Contracted | $162 | 351% |
| First Health | $188 | 408% |
Consumer Guidance & Cost Commentary
For the CPT code 97760, "Orthotic fitting and training," the facility in Lawrence, KS, lists a cash median price of $51.00, which is significantly lower than the state average of $162.00. While the facility's negotiated rates with major payers like Blue Cross Blue Shield and UnitedHealthcare range from $40 to $185, these amounts often exceed the cash price, meaning patients with high-deductible plans might save money by paying out-of-pocket. It is important to note that commercial rates can sometimes be higher than cash prices due to administrative costs and contract structures, so verifying the "self-pay" or "prompt-pay" discount before scheduling is essential. If you choose to use insurance, be aware that the allowed amount varies by plan, with some non-contracted or out-of-network scenarios potentially leading to balance billing, though federal protections like the No Surprises Act may limit these charges for emergency or certain non-emergency services at in-network facilities.
The Medicare benchmark for this service is $46.09, which serves as a reliable baseline for evaluating the facility's pricing markup. The facility's cash rate of $51.00 is slightly above the Medicare amount, while the median negotiated rate of $54.00 reflects the typical administrative load and contract dynamics that inflate commercial rates. Given that over 80% of hospital bills contain errors, patients should request a detailed, itemized bill rather than accepting a summary invoice to identify any unbundled codes or services not rendered. If you receive a bill that seems unusually high, you have the right to dispute it in writing with the billing supervisor to ensure accuracy