Orthotic fitting and training
Facility: Providence Medical Center
Billing Code: 97760 (CPT)
- CPT Billing Code: 97760
- Insurance Median: $51
- Cash Discount Price: $43
- vs. Medicare Baseline: 1.11x 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 |
|---|---|---|
| UnitedHealthcare | $43 - $137 | 93% |
| Midland Care Connection | $43 | 93% |
| Cigna | $43 | 93% |
| Medicare (plans) | $43 | 93% |
| Aetna | $43 | 93% |
| Tricare | $43 | 93% |
| Blue Cross Blue Shield | $43 - $103 | 93% |
| Celtic | $45 - $69 | 98% |
| Healthy Blue | $45 | 98% |
| Kansas Superior Select | $45 | 98% |
| Corizon | $56 | 122% |
| Well Path Prison | $60 | 130% |
| Employer Direct Healthcare | $60 | 130% |
| Centurion | $65 | 141% |
| Naphcare | $67 | 145% |
Consumer Guidance & Cost Commentary
For this orthotic fitting and training service at Providence Medical Center in Kansas City, KS, the cash price is $43.00, which aligns with the lowest negotiated rates observed across 15 payers, including UnitedHealthcare and Blue Cross Blue Shield. While the facility's cash rate matches the state average of $43.00, it is significantly lower than the median negotiated amount of $51.00 and the gross charge of $449.00. Patients with high-deductible plans may find paying the cash price upfront more cost-effective than relying on insurance, as the negotiated rates for major carriers often exceed the cash rate. To secure the lowest possible price, patients should explicitly request a self-pay classification or prompt-pay discount before scheduling, ensuring the billing system does not automatically submit a claim to an insurer that would void the cash agreement.
The facility's cash rate of $43.00 is also lower than the Medicare benchmark of $46.09, indicating that the cash price is already below the federal cost baseline for this procedure. Although the facility is a voluntary non-profit church-owned acute care hospital with a rating of 3, the pricing structure suggests that commercial insurance contracts result in higher net costs for patients compared to direct payment. Because the cash price is lower than the median negotiated rate of $51.00, patients should verify their specific plan's allowed amount before treatment to avoid balance billing or unexpected out-of-pocket expenses. If a patient receives a bill exceeding the cash price, they should request an itemized audit to identify unbundled codes or services not rendered, as over 80% of hospital bills contain errors that can be corrected through formal