Orthotic fitting and training
Facility: Amberwell Atchison Association
Billing Code: 97760 (CPT)
- CPT Billing Code: 97760
- Insurance Median: $95
- Cash Discount Price: $205
- vs. Medicare Baseline: 2.06x 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 206% of the Medicare baseline (a markup of 106%). 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 | $38 - $40 | 82% |
| Va Ccn - All Plans | $55 - $80 | 119% |
| UnitedHealthcare | $55 - $434 | 119% |
| Superior Select Mcr Adv - All Plans | $55 - $80 | 119% |
| Humana | $55 - $109 | 119% |
| Triwest - All Plans | $55 - $80 | 119% |
| Ambetter / Centene | $86 - $124 | 187% |
| Aetna | $92 - $133 | 200% |
| Cigna | $92 - $133 | 200% |
| Oscar - All Plans | $126 - $182 | 273% |
| Centrus Health Direct - All Plans | $126 - $182 | 273% |
| Multiplan - All Plans | $131 - $189 | 284% |
| Wppa Providrs Care - All Plans | $151 - $218 | 328% |
Consumer Guidance & Cost Commentary
For the CPT code 97760, representing orthotic fitting and training, the facility's cash price is $205.00, which matches the cash median for this service in Atchison, Kansas. While commercial insurance plans negotiate rates ranging from $38 to $434 depending on the carrier, the cash price can sometimes be more affordable for patients with high-deductible plans or those who have already met their out-of-pocket maximums. It is important to note that many commercial payers, such as UnitedHealthcare and Ambetter/Centene, have negotiated rates that exceed the cash price, meaning paying out-of-pocket might result in lower costs if you do not have active insurance coverage.
The Medicare benchmark for this procedure is $46.09, which serves as the objective baseline for evaluating pricing markups. The facility's cash rate of $205.00 represents a significant markup compared to the Medicare amount, consistent with how commercial rates often average 200% to 300% of the Medicare benchmark. To potentially reduce your final bill, you should contact the facility directly to inquire about "self-pay" or "prompt-pay" discounts, which can offer a fee reduction of 20% to 50% for upfront payment. Additionally, since the facility is a Critical Access Hospital in Atchison, KS, you may find that local county or state average rates provide further context for fair pricing, but the most reliable method to avoid balance billing is to verify your specific plan's allowed amount before scheduling care.