Orthotic fitting and training
Facility: Memorial Hospital
Billing Code: 97760 (CPT)
- CPT Billing Code: 97760
- Insurance Median: $150
- Cash Discount Price: $243
- vs. Medicare Baseline: 3.25x 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 325% of the Medicare baseline (a markup of 225%). 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 | $42 | 91% |
| Tricare | $106 - $137 | 230% |
| Humana | $106 - $137 | 230% |
| Medicare (plans) | $107 - $138 | 232% |
| Ambetter / Centene | $117 - $150 | 254% |
| Coventry - All Other Plans | $191 - $246 | 414% |
| Health Partners Of Kansas - All Plans | $202 - $260 | 438% |
| Preferred Healthcare-All Plans | $202 - $260 | 438% |
| Wppa/Providers Care-All Plans | $297 - $383 | 644% |
Consumer Guidance & Cost Commentary
For the CPT code 97760, representing orthotic fitting and training at Memorial Hospital in Abilene, KS, the cash price is $243.00, which matches the facility's median negotiated rate. This cash price is notably higher than the state average for this service, which is $144.00. While commercial insurance plans like Blue Cross Blue Shield and Tricare negotiate rates ranging from $42 to $260, patients with high-deductible plans may find paying cash directly cheaper if their insurance allowed amount exceeds the cash price. It is important to note that commercial negotiated rates often include administrative overhead and can be significantly higher than the true cost of care, which is better reflected by the Medicare benchmark of $46.09.
Patients should be aware that while the No Surprises Act protects against balance billing for out-of-network providers at in-network facilities, unexpected charges can still occur for ancillary services or if a provider is out-of-network. To avoid surprise bills, consumers should request a full itemized CPT-coded bill before paying, as summary invoices may hide unbundled charges or services not rendered. Additionally, Memorial Hospital offers a prompt-pay discount for patients who settle their balance upfront, which can reduce the total cost. Before scheduling, it is advisable to confirm the facility's self-pay or prompt-pay rates and ensure any consent forms do not inadvertently waive rights to dispute out-of-network costs.