Orthotic fitting and training
Facility: Mercy Hospital Columbus
Billing Code: 97760 (CPT)
- CPT Billing Code: 97760
- Insurance Median: $103
- Cash Discount Price: $92
- vs. Medicare Baseline: 2.23x 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 223% of the Medicare baseline (a markup of 123%). 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 |
|---|---|---|
| Medicaid / KanCare | $35 - $102 | 76% |
| UnitedHealthcare | $40 - $117 | 87% |
| Blue Cross Blue Shield | $40 - $102 | 87% |
| Humana | $41 - $134 | 89% |
| Medicare (plans) | $43 - $106 | 93% |
| Health Systems Inc Contracted [320174] | $61 | 132% |
| Insurance System Inc Contracted [320465] | $61 | 132% |
| Administrative Payor Contracted [320005] | $63 | 137% |
| Mercy Hospice Okc [20252] | $102 | 221% |
| Ambetter / Centene | $102 | 221% |
| Provider Partners Health Plans Contracted [320450] | $102 | 221% |
| Medical Associates Health Contracted [320444] | $102 | 221% |
| Cherokee Nation Health Serv Contracted [320066] | $102 | 221% |
| Halo Hcr Inc Hospice [20432] | $102 | 221% |
| Halo Hcr Inc Hospice Contracted [320432] | $102 | 221% |
| Qual Choice Contracted [320325] | $102 | 221% |
| Indian Health Service Contracted [320198] | $102 | 221% |
| Elara Caring Aspire Hospice [20433] | $102 | 221% |
| Globalhealth Contracted [320145] | $102 | 221% |
| Cigna | $102 | 221% |
| Kindful Hospice Contracted [320434] | $102 | 221% |
| Home State Health Plan Contracted [320187] | $102 | 221% |
| Pace Of The Ozarks Contracted [320518] | $102 | 221% |
| Novasys Contracted [320285] | $102 | 221% |
| Aetna | $102 - $127 | 221% |
| Dept Of Veteran Affairs Contracted [320106] | $102 | 221% |
| Kindful Hospice [20434] | $102 | 221% |
| Centurion Of Missouri [20459] | $102 | 221% |
| Cross Timbers Hospice [20098] | $102 | 221% |
| Mercy Mgd Behavioral Health Contracted [320259] | $102 | 221% |
| Tricare | $103 | 223% |
| Healthscope Contracted [320182] | $109 | 236% |
| Workers Comp [20426] | $113 - $120 | 245% |
| United Medical Resources Contracted [320454] | $117 - $134 | 254% |
| Medica Contracted [320239] | $126 | 273% |
| American Healthcare Alliance Contracted [320020] | $127 | 276% |
| First Health Contracted [320128] | $127 | 276% |
| Usa Managed Care Org Contracted [320429] | $127 | 276% |
| Mercy Benefit Admin Contracted [320251] | $127 - $134 | 276% |
| Federal Medical Center Contracted [320127] | $127 | 276% |
| Healthlink Contracted [320179] | $127 - $134 | 276% |
| Preferred Health Plan Contracted [320522] | $127 | 276% |
| Benefit Management Contracted [320052] | $134 | 291% |
| Aither Health Contracted [320449] | $134 | 291% |
| Edison Health Solutions Contracted [320502] | $134 | 291% |
| 90 Degree Benefits Contracted [320436] | $134 | 291% |
| Point C Contracted [320238] | $134 | 291% |
| Private Health Care Systems Contracted [320320] | $134 | 291% |
| Ppo Plus Contracted [320310] | $134 | 291% |
| Imagine 360 Contracted [320494] | $134 | 291% |
| Auxiant Contracted [320462] | $134 | 291% |
| Reflect Health Contracted [320492] | $134 | 291% |
| Ebms Contracted [320493] | $134 | 291% |
| Show-Me Health Administrators Contracted [320483] | $134 | 291% |
| Yuzu Health Contracted [320521] | $134 | 291% |
Consumer Guidance & Cost Commentary
For the CPT code 97760, "Orthotic fitting and training," Mercy Hospital Columbus charges a gross rate of $141.00, which is significantly higher than the state average for Kansas. The facility's cash median price is $92.00, while the median negotiated rate across payers is $103.00. It is important to note that while commercial insurance contracts often result in higher allowed amounts due to administrative overhead and multi-layered payer dynamics, paying cash directly can sometimes be more cost-effective for patients with high-deductible plans. If your insurance allows a rate exceeding the cash price, paying out-of-pocket may reduce your immediate financial burden, provided you have sufficient funds.
Patients should proactively ask the hospital about "self-pay" or "prompt-pay" discounts before scheduling services, as these upfront payment incentives can bypass costly insurance billing cycles and administrative fees. Additionally, because Medicare serves as the objective baseline for healthcare pricing, the facility's Medicare amount of $46.09 reveals that commercial rates are substantially marked up compared to the federal government's cost-based reimbursement. To ensure you are receiving fair pricing, verify your specific plan's negotiated rate before the visit and request a detailed, itemized bill to identify any errors or unbundled charges that could be disputed.