Orthotic fitting and training
Facility: Decatur Health
Billing Code: 97760 (CPT)
- CPT Billing Code: 97760
- Insurance Median: $89
- Cash Discount Price: $131
- vs. Medicare Baseline: 1.93x 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 |
|---|---|---|
| Wppa/Providrs Care- All Plans | $41 - $88 | 89% |
| UnitedHealthcare | $42 - $111 | 91% |
| Humana | $42 - $90 | 91% |
| Blue Cross Blue Shield | $51 | 111% |
| Aetna | $61 - $146 | 132% |
| Midlands Choice- All Plans | $61 - $131 | 132% |
| Medicaid / KanCare | $69 - $148 | 150% |
Consumer Guidance & Cost Commentary
For the CPT code 97760, "Orthotic fitting and training," Decatur Health in Oberlin, KS, lists a cash price of $131.00, which is notably higher than the state average cash median of $89.00. While commercial payers like UnitedHealthcare and Aetna have negotiated rates ranging from $42 to $148, these amounts often exceed the cash price, meaning patients with high-deductible plans might save money by paying out-of-pocket. It is important to verify your specific plan's deductible status before scheduling, as paying the full negotiated rate without meeting your deductible can result in significantly higher out-of-pocket costs than paying the cash rate directly.
To ensure you are not overcharged, always request an itemized bill before paying, as summary invoices can hide unbundled charges or services not rendered. Additionally, ask the facility about "self-pay" or "prompt-pay" discounts, which can reduce the final amount owed by 20% to 50% if paid upfront. If you receive a balance bill from an out-of-network provider at this in-network facility, remember that the No Surprises Act generally protects you from paying the difference between the provider's full charge and your insurance allowed amount for non-emergency services.