Orthotic fitting and training
Facility: Scott County Hospital
Billing Code: 97760 (CPT)
- CPT Billing Code: 97760
- Insurance Median: $121
- Cash Discount Price: Unavailable
- vs. Medicare Baseline: 2.63x 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 263% of the Medicare baseline (a markup of 163%). 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 | $40 | 87% |
| UnitedHealthcare | $54 - $127 | 117% |
| Humana | $56 | 122% |
| Wppa | $80 - $1,200 | 174% |
| Aetna | $121 | 263% |
Consumer Guidance & Cost Commentary
For the CPT code 97760, representing orthotic fitting and training at Scott County Hospital in Scott City, KS, the facility's gross charge is $134.00. While the hospital is a Critical Access Hospital owned by a voluntary non-profit, the negotiated rates vary significantly by insurer, ranging from $40.00 with Blue Cross Blue Shield to $1,200.00 with WPPA. It is important to note that these negotiated rates often exceed the actual cost of care due to administrative overhead and contract dynamics; for instance, the median negotiated rate of $121.00 is substantially higher than the Medicare benchmark of $46.09, which serves as a scientifically validated baseline for the true cost of this service. Patients should be aware that assuming an in-network rate is the lowest possible price can be misleading, as different payers within the same network may have vastly different contract terms.
For patients with high-deductible plans, paying cash or utilizing a prompt-pay discount may result in lower out-of-pocket costs compared to the insurance negotiated rate, particularly given that the cash median is not listed but the gross charge is significantly higher than the Medicare amount. The No Surprises Act provides federal protection against balance billing for out-of-network services at in-network facilities, though patients should still request a detailed, itemized bill to verify that all charges are accurate and that no unbundled codes or services not rendered have been included. Before scheduling, it is advisable to explicitly ask the hospital about self-pay or prompt-pay discounts, which can range from 20% to 50% off the billed amount, and to sign a waiver of insurance submission to