Orthotic fitting and training
Facility: Fredonia Regional Hospital
Billing Code: 97760 (CPT)
- CPT Billing Code: 97760
- Insurance Median: $52
- Cash Discount Price: $57
- vs. Medicare Baseline: 1.13x 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 | $28 - $40 | 61% |
| Veterans Programs - All Plans | $29 | 63% |
| Aetna | $29 - $52 | 63% |
| UnitedHealthcare | $29 - $229 | 63% |
| Cigna | $52 | 113% |
| Reserve National-All Plans | $52 | 113% |
| Meritain-All Plans | $52 | 113% |
Consumer Guidance & Cost Commentary
For the CPT code 97760, representing orthotic fitting and training, the cash price at Fredonia Regional Hospital in Kansas is $57.00, which matches the facility's cash median. This rate is notably higher than the state average of $46.09, which is based on Medicare reimbursement. While commercial insurance plans like UnitedHealthcare and Aetna have negotiated rates ranging from $29 to $229, these figures often exceed the cash price. Patients with high-deductible plans may find paying the $57.00 cash rate directly more cost-effective than relying on insurance, especially if their out-of-pocket costs or negotiated allowed amounts are higher. It is advisable to contact the hospital directly to inquire about self-pay or prompt-pay discounts, which can reduce the final bill by offering immediate liquidity incentives.
The facility, a Critical Access Hospital with government-local ownership, reports a median paid amount of $52.00 across seven payers, though individual negotiated rates vary significantly, with UnitedHealthcare showing a wide range up to $229. Because commercial rates can sometimes be inflated by administrative processing costs and contract dynamics, it is important to verify the specific allowed amount for your plan before scheduling. If you receive a bill that exceeds the cash price or your expected insurance payment, you should request an itemized billing audit to identify potential errors, such as unbundled codes or services not rendered, as over 80% of hospital bills contain inaccuracies. Additionally, under the No Surprises Act, you are protected from balance billing for out-of-network services at in-network facilities, so any unexpected charges should be disputed with the insurer rather than paid immediately.