Orthotic fitting and training
Facility: Mercy Specialty Hospital Southeast Kansas
Billing Code: 97760 (CPT)
- CPT Billing Code: 97760
- Insurance Median: $89
- Cash Discount Price: $97
- vs. Medicare Baseline: 1.93x 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 | $30 - $42 | 65% |
| Medicaid / KanCare | $40 - $42 | 87% |
| Aetna | $40 - $74 | 87% |
| UnitedHealthcare | $40 - $138 | 87% |
| Humana | $41 - $43 | 89% |
| Kindful Hospice Contracted [320434] | $42 | 91% |
| Centivo Contracted [320505] | $42 | 91% |
| Cross Timbers Hospice [20098] | $42 | 91% |
| Medical Associates Health Contracted [320444] | $42 | 91% |
| Medicare (plans) | $42 | 91% |
| Elara Caring Aspire Hospice [20433] | $42 | 91% |
| Qual Choice Contracted [320325] | $42 | 91% |
| Cherokee Nation Health Serv Contracted [320066] | $42 | 91% |
| Cigna | $42 - $115 | 91% |
| Globalhealth Contracted [320145] | $42 | 91% |
| Halo Hcr Inc Hospice Contracted [320432] | $42 | 91% |
| Tricare | $42 | 91% |
| Mercy Mgd Behavioral Health Contracted [320259] | $42 | 91% |
| Mercy Hospice Okc [20252] | $42 | 91% |
| Halo Hcr Inc Hospice [20432] | $42 | 91% |
| Pace Of The Ozarks Contracted [320518] | $42 | 91% |
| Kindful Hospice [20434] | $42 | 91% |
| Dept Of Veteran Affairs Contracted [320106] | $43 | 93% |
| Provider Partners Health Plans Contracted [320450] | $45 | 98% |
| Medica Contracted [320239] | $54 | 117% |
| First Health Contracted [320128] | $74 | 161% |
| Point C Contracted [320238] | $74 - $112 | 161% |
| Providrs Care Network Contracted [320484] | $82 | 178% |
| Mercy Benefit Admin Contracted [320251] | $89 - $104 | 193% |
| Show-Me Health Administrators Contracted [320483] | $89 | 193% |
| United Medical Resources Contracted [320454] | $102 - $112 | 221% |
| American Healthcare Alliance Contracted [320020] | $104 | 226% |
| Edison Health Solutions Contracted [320502] | $104 | 226% |
| Ebms Contracted [320493] | $104 | 226% |
| Aither Health Contracted [320449] | $104 | 226% |
| Reflect Health Contracted [320492] | $104 | 226% |
| Yuzu Health Contracted [320521] | $104 | 226% |
| Imagine 360 Contracted [320494] | $104 | 226% |
| Auxiant Contracted [320462] | $104 - $112 | 226% |
| Healthlink Contracted [320179] | $112 | 243% |
| Federal Medical Center Contracted [320127] | $112 | 243% |
| Preferred Health Plan Contracted [320522] | $112 | 243% |
| Benefit Management Contracted [320052] | $112 | 243% |
| Health Systems Inc Contracted [320174] | $112 | 243% |
| Insurance System Inc Contracted [320465] | $112 | 243% |
| Healthscope Contracted [320182] | $112 | 243% |
| Compcare Of The Ozarks Contracted [320437] | $118 | 256% |
| Workers Comp [20426] | $119 | 258% |
| Private Health Care Systems Contracted [320320] | $138 | 299% |
| Multiplan Contracted [320270] | $142 | 308% |
| Multiplan [20270] | $142 | 308% |
Consumer Guidance & Cost Commentary
For the CPT code 97760, representing orthotic fitting and training, the facility's cash price is $97.00, which is notably higher than the state-wide median paid amount of $40.00. While commercial insurance plans typically negotiate rates ranging from $30 to $142, many in-network payers, such as Blue Cross Blue Shield and Medicaid/KanCare, have negotiated ceilings between $30 and $42. This suggests that for patients with high-deductible plans, paying the cash price directly could be more cost-effective than relying on insurance, as the negotiated rates often exceed the cash price due to administrative overheads. Patients should verify their specific plan's allowed amount before scheduling, as assuming in-network status guarantees the lowest price can lead to unexpected costs if the facility's contract rate is higher than the cash option.
The facility's Medicare benchmark rate of $46.09 serves as a critical baseline for evaluating pricing fairness, indicating that commercial negotiated rates often carry significant markups above this federal standard. For instance, while the median negotiated rate across payers is $89.00, some contracts reach as high as $142.00, reflecting the variability in payer-provider agreements. To optimize costs, patients should inquire about prompt-pay discounts, which can reduce bills by 20% to 50% if paid in full upfront, bypassing the administrative costs associated with insurance claims. Additionally, requesting an itemized billing audit is recommended to identify any errors or unbundled charges, as over 80% of hospital bills contain discrepancies that can be resolved to lower the final amount owed.