Orthotic fitting and training
Facility: Smith County Memorial Hospital
Billing Code: 97760 (CPT)
- CPT Billing Code: 97760
- Insurance Median: $71
- Cash Discount Price: $75
- vs. Medicare Baseline: 1.54x 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 | 85% |
| Medicaid / KanCare | $52 - $75 | 113% |
| Multiplan-All Plans | $68 | 148% |
| Wppa-All Plans | $70 | 152% |
| Midlands Choice-All Plans | $71 | 154% |
| Health Partners Of Ks Ppo-All Plans | $71 | 154% |
| UnitedHealthcare | $71 | 154% |
Consumer Guidance & Cost Commentary
For the CPT code 97760, representing orthotic fitting and training, Smith County Memorial Hospital in Smith Center, KS, lists a cash price of $75.00, which matches the facility's cash median. This rate is significantly higher than the Medicare benchmark of $46.09, reflecting a markup of 1.5 times the federal baseline. While commercial payers negotiate rates ranging from $39 to $75 depending on the plan, the cash price remains the lowest option available for patients without insurance. It is important to note that for individuals with high-deductible plans, paying the cash price of $75.00 upfront may be more cost-effective than relying on insurance, as the negotiated rates paid by insurers often exceed the cash amount due to administrative overhead and contract structures.
Patients should proactively inquire about "self-pay" or "prompt-pay" discounts before scheduling, as these programs can reduce the final bill by 20% to 50% by bypassing costly insurance billing cycles. Although the facility is a Critical Access Hospital with government-local ownership, the data does not provide specific county or state average comparisons for this procedure, so the $75.00 cash rate should be viewed as the primary benchmark for self-pay. To ensure accuracy, consumers should request a full itemized bill rather than accepting a summary invoice, as over 80% of hospital bills contain errors such as double-billing or unbundled codes. If a balance bill arises from an out-of-network service, the No Surprises Act may provide protections against unexpected charges, and patients should verify their deductible status before assuming the negotiated rate will cover their costs.