Orthotic fitting and training
Facility: Rooks County Health Center
Billing Code: 97760 (CPT)
- CPT Billing Code: 97760
- Insurance Median: $94
- Cash Discount Price: $78
- vs. Medicare Baseline: 2.04x 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 204% of the Medicare baseline (a markup of 104%). 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 | $40 | 87% |
| Tricare | $49 | 106% |
| Celtic Mcr Adv | $49 | 106% |
| Veterans Admin - All Plans | $49 | 106% |
| Celtic Comm - All Other Plans | $54 | 117% |
| Preferred Benefits Admin | $94 | 204% |
| Aetna | $94 | 204% |
| UnitedHealthcare | $94 | 204% |
| Health Partners - All Plans | $99 | 215% |
| Preferred Hlthcare - All Other Plans | $99 | 215% |
| Healthy Blue Mcaid - All Plans | $104 | 226% |
Consumer Guidance & Cost Commentary
For the CPT code 97760, representing orthotic fitting and training, the facility's cash median rate is $78.00, which is lower than the state average of $94.00. While many commercial payers negotiate rates significantly higher than the cash price—ranging from $40 to $104 depending on the insurer—patients with high-deductible plans may find paying the cash rate directly more cost-effective if their insurance allowed amount exceeds $78.00. To ensure you receive the best possible price, it is essential to ask the hospital about self-pay or prompt-pay discounts before scheduling, as these upfront incentives can reduce the final bill by 20% to 50% by bypassing administrative fees associated with insurance claims.
When reviewing your final invoice, always request a detailed itemized bill rather than accepting a summary statement, as over 80% of hospital bills contain errors such as unbundled codes or charges for services not rendered. If you receive a balance bill from an out-of-network provider, remember that the No Surprises Act protects you from paying the difference between the provider's full charge and your insurance allowed amount for emergency care and non-emergency services at in-network facilities. For pricing context, this service's Medicare benchmark is $46.09, meaning commercial negotiated rates often reflect a markup above the federal government's calculated cost baseline. Comparing your specific facility's negotiated rates against this Medicare standard provides a clearer picture of fair pricing than comparing them to the inflated hospital chargemaster list.