Orthotic fitting and training
Facility: Medicine Lodge Memorial Hospital
Billing Code: 97760 (CPT)
- CPT Billing Code: 97760
- Insurance Median: $67
- Cash Discount Price: $70
- vs. Medicare Baseline: 1.45x 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 |
|---|---|---|
| Tricare | $56 | 122% |
| Humana | $64 | 139% |
| Aetna | $65 - $70 | 141% |
| UnitedHealthcare | $66 | 143% |
| Hpk-All Plans | $66 | 143% |
| Medicaid / KanCare | $70 | 152% |
Consumer Guidance & Cost Commentary
For the CPT code 97760, representing orthotic fitting and training, the facility's cash price is $70.00, which matches the gross charge and the median negotiated rate across all six payers listed. While the facility is a Critical Access Hospital in Medicine Lodge, KS, with a government ownership structure, the data indicates that the cash price is significantly higher than the Medicare benchmark of $46.09, reflecting a markup of 1.5 times the federal rate. This suggests that for patients with high-deductible plans or those without insurance, paying the full cash price of $70.00 upfront may be more cost-effective than relying on insurance, as the negotiated rates for payers like Aetna range from $65.00 to $70.00, which could still exceed the cash amount depending on specific plan deductibles and coinsurance.
To minimize costs, patients should proactively request a "self-pay" or "prompt-pay" discount before scheduling, as these upfront payment incentives can reduce the bill by 20% to 50% by bypassing administrative claim processing fees. It is also important to avoid accepting summary bills without demanding a full itemized statement to ensure no unbundled codes or services not rendered are included in the final charge. Given that the facility's rates are based on a government hospital district, patients should verify their specific plan's allowed amount, as the median negotiated rate of $67.00 is slightly lower than the gross charge but still represents a premium over the Medicare baseline.