Orthotic fitting and training
Facility: Hiawatha Community Hospital
Billing Code: 97760 (CPT)
- CPT Billing Code: 97760
- Insurance Median: $155
- Cash Discount Price: $205
- vs. Medicare Baseline: 3.36x 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 336% of the Medicare baseline (a markup of 236%). 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 | $38 - $40 | 82% |
| UnitedHealthcare | $62 - $208 | 135% |
| Aetna | $62 - $196 | 135% |
| Humana | $63 - $90 | 137% |
| Ambetter / Centene | $75 - $107 | 163% |
| Oscar - All Plans | $126 - $182 | 273% |
| Centrus Health Direct - All Plans | $126 - $182 | 273% |
| Preferred Hlth - All Plans | $151 - $218 | 328% |
| Wppa Providrs Care - All Plans | $160 - $230 | 347% |
| Cigna | $160 - $230 | 347% |
| Multiplan - All Plans | $163 - $235 | 354% |
| Midlands Choice - All Plans | $163 - $235 | 354% |
| Healthy Blue Mcaid - All Plans | $168 - $242 | 365% |
Consumer Guidance & Cost Commentary
For the CPT code 97760, representing orthotic fitting and training, Hiawatha Community Hospital in Hiawatha, KS, lists a cash median price of $205.00, which matches the facility's gross charge. This cash rate is significantly higher than the state average, as indicated by a 3.4x markup relative to the Medicare benchmark of $46.09. While commercial insurance plans like Blue Cross Blue Shield and UnitedHealthcare negotiate rates ranging from $38 to $230, these negotiated amounts often exceed the cash price. Patients with high-deductible plans may find paying the $205.00 cash rate directly more cost-effective than relying on insurance, which could result in out-of-pocket costs exceeding the cash price if their deductible has not been met or if their plan allows a high allowed amount.
To minimize potential financial exposure, consumers should proactively request a "self-pay" or "prompt-pay" discount from the hospital before scheduling services, as these upfront payment incentives can reduce the total cost. It is also critical to avoid accepting summary bills that obscure individual charges; instead, patients should demand a full itemized audit to verify that no unbundled codes or services not rendered are included, as over 80% of hospital bills contain errors. Under federal protections like the No Surprises Act, patients are generally shielded from balance billing for out-of-network services at in-network facilities, but they must remain vigilant against unexpected ancillary charges or consent waivers that could void these safeguards.