Orthotic fitting and training
Facility: Susan B Allen Memorial Hospital
Billing Code: 97760 (CPT)
- CPT Billing Code: 97760
- Insurance Median: $554
- Cash Discount Price: $138
- vs. Medicare Baseline: 12.02x 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 1202% of the Medicare baseline (a markup of 1102%). 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 |
|---|---|---|
| UnitedHealthcare | $350 | 759% |
| Providrs Care | $757 | 1642% |
Consumer Guidance & Cost Commentary
For the CPT code 97760, representing orthotic fitting and training, Susan B Allen Memorial Hospital in El Dorado, KS, lists a cash median price of $138.00. This cash rate is notably lower than the facility's negotiated rates with UnitedHealthcare ($350.00) and Providrs Care ($757.00), which are significantly higher than the cash price. While the facility's cash rate is 12.0% higher than the Medicare benchmark of $46.09, patients with high-deductible plans may find paying the cash price directly more cost-effective than relying on insurance, as the negotiated amounts exceed the cash option. Given that the facility is a voluntary non-profit acute care hospital, patients should explicitly ask about "self-pay" or "prompt-pay" discounts before scheduling to ensure they are receiving the lowest possible rate.
It is important to understand that the high negotiated rates with major payers like UnitedHealthcare and Providrs Care reflect standard insurance contracts that include administrative overhead and do not represent the true cost of care. The Medicare amount of $46.09 serves as a scientifically validated baseline for the "true cost" of this service, whereas commercial rates often include markups that can inflate the final bill. If a patient receives a balance bill from an out-of-network provider at this facility, they may be liable for the difference between the provider's full chargemaster and the insurance allowed amount, though the No Surprises Act protects patients from such surprise billing for emergency and non-emergency services at in-network facilities. To avoid unexpected costs, patients should request a full itemized CPT-coded bill before paying, as