Orthotic fitting and training
Facility: Lindsborg Community Hospital
Billing Code: 97760 (CPT)
- CPT Billing Code: 97760
- Insurance Median: $116
- Cash Discount Price: $117
- vs. Medicare Baseline: 2.52x 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 252% of the Medicare baseline (a markup of 152%). 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 |
|---|---|---|
| Coventry Mcr Adv | $31 - $130 | 67% |
| Tricare | $31 - $128 | 67% |
| Blue Cross Blue Shield | $39 | 85% |
| Cigna | $56 - $232 | 122% |
| Coventry Comm-All Other Plans | $59 - $246 | 128% |
| UnitedHealthcare | $59 - $246 | 128% |
| Phcs Preferred-All Plans | $61 - $254 | 132% |
| Multiplan-All Plans | $61 - $254 | 132% |
| Health Partners -All Plans | $63 - $260 | 137% |
| Wppa-All Plans | $63 - $260 | 137% |
| Coventry Wc | $63 - $260 | 137% |
| Century Health-All Plans | $63 - $260 | 137% |
Consumer Guidance & Cost Commentary
For the CPT code 97760, representing orthotic fitting and training, the cash median price at Lindsborg Community Hospital is $117.00, while the median negotiated rate paid by insurers is $116.00. This service is provided at a Critical Access Hospital in Lindsborg, KS, with a Medicare benchmark of $46.09. When compared to the Medicare rate, the facility's cash price represents a 2.5x markup, which aligns with the typical range where commercial rates can average 200% to 300% of the federal baseline. Because the cash price is only slightly higher than the negotiated rate, patients with high-deductible plans may find paying out-of-pocket directly is a viable option to avoid potential deductibles, provided they confirm the facility's self-pay or prompt-pay discounts before scheduling.
Insurance coverage for this service varies significantly across the 12 payers represented, with negotiated amounts ranging from a low of $31 to a high of $260 depending on the specific plan. For instance, Coventry Mcr Adv and Tricare have the lowest negotiated ceilings at $31 and $128 respectively, whereas Phcs Preferred-All Plans and Multiplan-All Plans have the highest at $254. Patients should be aware that assuming an in-network status guarantees the lowest price is a common pitfall, as different insurers negotiate different maximums. To ensure the most accurate pricing, it is essential to verify your specific plan's allowed amount and check for any prompt-pay discounts that could reduce the final balance before the service is rendered.