Orthotic fitting and training
Facility: Wilson Medical Center
Billing Code: 97760 (CPT)
- CPT Billing Code: 97760
- Insurance Median: $62
- Cash Discount Price: $59
- vs. Medicare Baseline: 1.35x 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 |
|---|---|---|
| Blue Cross Blue Shield | $39 - $78 | 85% |
| Humana | $41 | 89% |
| Tricare | $41 | 89% |
| UnitedHealthcare | $41 - $73 | 89% |
| Ambetter / Centene | $41 - $78 | 89% |
| Aetna | $41 - $78 | 89% |
| Cigna | $62 | 135% |
| Health Partners-All Plans | $72 | 156% |
| Mulitplan-All Plans | $72 | 156% |
Consumer Guidance & Cost Commentary
For the CPT code 97760, representing orthotic fitting and training, Wilson Medical Center in Neodesha, KS, lists a gross charge of $78.00. While the facility's cash median rate is $59.00, which is lower than the state average of $62.00, patients should be aware that insurance negotiated rates often exceed cash prices due to administrative overhead. For instance, UnitedHealthcare and Ambetter/Centene have negotiated ranges reaching up to $78.00, while Humana, Tricare, and Cigna have fixed negotiated rates of $41.00. Because commercial contracts can include multi-layered administrative structures that inflate baseline prices by 20% to 40%, paying cash upfront may result in a lower out-of-pocket cost for individuals with high-deductible plans, provided they secure a self-pay or prompt-pay discount before scheduling.
The facility's Medicare benchmark rate for this service is $46.09, serving as the objective baseline for evaluating pricing markup. The facility's cash rate of $59.00 represents a 1.3x multiplier compared to the Medicare amount, which aligns with the typical fair pricing range of 120% to 150% of Medicare, whereas commercial negotiated rates often average 200% to 300% of this benchmark. Given that over 80% of hospital bills contain errors, patients are encouraged to request a detailed, itemized billing audit to identify any unbundled codes or services not rendered before finalizing payment. Additionally, under the No Surprises Act, patients are protected from balance billing for out