Orthotic fitting and training
Facility: Wamego Health Center
Billing Code: 97760 (CPT)
- CPT Billing Code: 97760
- Insurance Median: $25
- Cash Discount Price: $128
- vs. Medicare Baseline: 0.54x 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 |
|---|---|---|
| UnitedHealthcare | $24 | 52% |
| Aetna | $25 | 54% |
| Medicaid / KanCare | $25 | 54% |
| Blue Cross Blue Shield | $52 - $55 | 113% |
| Providrs Care | $59 | 128% |
Consumer Guidance & Cost Commentary
For the CPT code 97760, representing orthotic fitting and training, the Wamego Health Center in Wamego, KS, lists a cash median price of $128.00. This cash rate is significantly lower than the facility's gross charge of $320.00 and notably higher than the Medicare benchmark of $46.09. While the facility offers a median negotiated rate of $25.00 to insurance payers like UnitedHealthcare, Aetna, and Medicaid/KanCare, patients should be aware that cash payments can sometimes be more cost-effective if their insurance plan has a high deductible or if the negotiated rate exceeds the cash price. It is crucial to confirm with the hospital whether "self-pay" or "prompt-pay" discounts are available before scheduling, as these upfront payment incentives can further reduce the final bill by bypassing administrative claim processing costs.
When comparing pricing against broader benchmarks, the facility's cash rate of $128.00 does not directly align with state or county averages provided in this specific dataset, as the data focuses on payer-specific negotiated ranges and the Medicare baseline. However, the significant markup from the Medicare rate of $46.09 to the gross charge of $320.00 highlights the importance of understanding the difference between the facility's list price and actual reimbursement. Patients should avoid accepting summary bills and instead request a detailed, itemized statement to verify that all charges are accurate and that no services were unbundled or double-billed. By comparing the facility's negotiated rates against the Medicare benchmark and verifying their own insurance status, consumers can make informed decisions about whether to pay out-of-pocket or