Orthotic fitting and training
Facility: Ellsworth County Medical Center
Billing Code: 97760 (CPT)
- CPT Billing Code: 97760
- Insurance Median: $45
- Cash Discount Price: $50
- 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 |
|---|---|---|
| Triwest -All Plans | $24 | 52% |
| Healthy Blue Mcr Adv | $24 | 52% |
| Va Ccn-All Plans | $24 | 52% |
| Humana | $24 - $48 | 52% |
| UnitedHealthcare | $32 - $50 | 69% |
| Blue Cross Blue Shield | $37 - $39 | 80% |
| Aetna | $45 | 98% |
| First Health - All Plans | $45 | 98% |
| Cigna | $48 | 104% |
| Medicaid / KanCare | $50 | 108% |
| Healthy Blue Mcaid- All Other Plans | $50 | 108% |
| Coventry Mcaid-All Plans | $50 | 108% |
| Providers Care-Wppa-All Plans | $75 | 163% |
Consumer Guidance & Cost Commentary
For orthotic fitting and training at Ellsworth County Medical Center, the cash price is $50.00, which matches the facility's negotiated rate for Medicaid plans and the gross chargemaster. However, commercial insurance payers negotiate significantly lower rates, with Humana paying as low as $24 and UnitedHealthcare ranging from $32 to $50. This data highlights a key pricing dynamic: while cash payment appears straightforward, patients with high-deductible plans might find the insurance negotiated rate exceeds the cash price, potentially resulting in higher out-of-pocket costs if their deductible is not yet met. To minimize expenses, patients should verify their specific plan's allowed amount before scheduling and explicitly ask the hospital about "self-pay" or "prompt-pay" discounts, which can reduce the final bill by 20% to 50% if paid upfront.
The facility's pricing is anchored by a Medicare benchmark of $46.09, which serves as a scientifically validated baseline for healthcare costs. While the data provided does not include specific county or state average figures for comparison, the facility operates as a Critical Access Hospital in Ellsworth, KS, with a proprietary ownership structure. It is important to note that commercial rates often include administrative overhead and contract dynamics that can inflate the baseline price compared to the Medicare rate. Consumers should be aware that balance billing is generally prohibited for emergency care and non-emergency services at in-network facilities under the No Surprises Act, though unexpected charges can still occur if ancillary services are out-of-network. If a patient receives a bill that seems inconsistent with the negotiated rates, they should request a formal itemized audit to identify any errors, unbundled codes, or services not rendered before