Orthotic fitting and training
Facility: Golden Valley Memorial Hospital
Billing Code: 97760 (CPT)
- CPT Billing Code: 97760
- Insurance Median: $45
- Cash Discount Price: $76
- vs. Medicare Baseline: 0.98x 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 |
|---|---|---|
| Aetna | $42 | 91% |
| Humana | $42 | 91% |
| UnitedHealthcare | $42 - $71 | 91% |
| Home State Health | $45 | 98% |
| Ambetter / Centene | $50 | 108% |
| Medica | $166 | 360% |
Consumer Guidance & Cost Commentary
For the CPT code 97760 (Orthotic fitting and training) at Golden Valley Memorial Hospital in Clinton, Missouri, the cash median rate is $76. This facility, owned by a Government Hospital District, lists a gross charge of $127, while the median negotiated rate for in-network payers is $45. When compared to the state of Missouri, the facility's cash rate of $76 is higher than the state average, though the negotiated rate of $45 remains significantly lower than the gross charge of $127.
Patients with high-deductible plans may find paying cash upfront at $76 more cost-effective than using insurance, which has a median negotiated rate of $45 but could result in higher out-of-pocket costs if the patient's deductible has not been met. It is important to note that the median paid amount is not available in the data. To potentially reduce costs further, patients should request a self-pay or prompt-pay discount before scheduling, as these upfront payment incentives can lower the billed amount. Additionally, if the patient has out-of-network coverage, they should be aware of the No Surprises Act protections regarding balance billing, though this specific code is billed at a negotiated rate for in-network plans.