Orthotic fitting and training
Facility: Saint Luke'S South Hospital
Billing Code: 97760 (CPT)
- CPT Billing Code: 97760
- Insurance Median: $96
- Cash Discount Price: $205
- vs. Medicare Baseline: 2.08x 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 208% of the Medicare baseline (a markup of 108%). 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 |
|---|---|---|
| Medicaid / KanCare | $22 - $60 | 48% |
| Aetna | $30 - $324 | 65% |
| Transplants-Case Rates [5750] | $41 - $341 | 89% |
| UnitedHealthcare | $45 - $127 | 98% |
| Blue Cross Blue Shield | $45 - $96 | 98% |
| Humana | $83 - $109 | 180% |
| Cigna | $90 - $289 | 195% |
| First Health [5512] | $202 | 438% |
| Commercial-Contracted [8000] | $203 - $276 | 440% |
Consumer Guidance & Cost Commentary
For the Orthotic fitting and training service (CPT 97760) at Saint Luke's South Hospital in Overland Park, KS, the cash price of $341.00 is significantly higher than the facility's negotiated rate of $96.00 and the state average of $205.00. While the Medicare benchmark of $46.09 serves as the objective baseline for cost, commercial rates often exceed this by 200% to 300%, with this facility's cash price representing a substantial markup. Patients with high-deductible plans should consider that paying the cash price of $341.00 upfront may be more cost-effective than using insurance, as the negotiated rate of $96.00 could still result in out-of-pocket costs exceeding the cash amount if the patient has not yet met their deductible or faces high copays.
To minimize costs, patients should proactively request "self-pay" or "prompt-pay" discounts before scheduling, as these programs can reduce bills by 20% to 50% by bypassing administrative fees associated with insurance claims. It is crucial to verify the specific allowed amount with the insurance carrier, as in-network rates vary widely among the nine payers listed, ranging from $22 to $341.00. If a balance bill arises from out-of-network ancillary services, the No Surprises Act provides federal protections against surprise billing for non-emergency care at in-network facilities, and patients should always request a full itemized audit to identify any unbundled codes or services not rendered before making a payment.