Orthotic fitting and training
Facility: Holton Community Hospital
Billing Code: 97760 (CPT)
- CPT Billing Code: 97760
- Insurance Median: $45
- Cash Discount Price: $52
- vs. Medicare Baseline: 0.98x 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 |
|---|---|---|
| Medicaid / KanCare | $24 - $69 | 52% |
| UnitedHealthcare | $24 - $100 | 52% |
| Aetna | $24 - $82 | 52% |
| Humana | $29 - $44 | 63% |
| Kansas Superior Select - All Plans | $30 - $44 | 65% |
| Blue Cross Blue Shield | $38 - $39 | 82% |
| Preferred Health Freedom | $46 - $57 | 100% |
| Preferred Health Fn Select - All Other Plans | $46 - $57 | 100% |
| Preferred Health Professionals | $46 - $57 | 100% |
| Wppa Providers - All Plans | $52 - $65 | 113% |
Consumer Guidance & Cost Commentary
For the CPT code 97760, representing orthotic fitting and training, Holton Community Hospital lists a gross charge of $69.00. The facility's cash median price is $52.00, which is lower than the state average of $55.00. While commercial payers negotiate rates ranging from $24 to $100 depending on the plan, patients with high-deductible plans may find paying the cash price directly more cost-effective, as the negotiated rates often exceed the cash amount. It is important to note that cash-pay patients should proactively ask the hospital about "self-pay" or "prompt-pay" discounts, which can further reduce the final bill by bypassing administrative processing fees.
The facility's negotiated rates average $45.00, which is slightly below the cash median but still higher than the Medicare benchmark of $46.09. Under federal protections like the No Surprises Act, patients should be aware that balance billing for out-of-network services at this in-network Critical Access Hospital is generally prohibited, though they should verify that all ancillary services are covered by the same network. To ensure accuracy, patients should request a full itemized billing audit rather than accepting a summary bill, as over 80% of hospital bills contain errors such as unbundled codes or charges for services not rendered. By comparing the facility's rates directly to the Medicare baseline and confirming their deductible status, consumers can make informed decisions about their coverage and potential out-of-pocket costs.