Orthotic fitting and training
Facility: Children'S Mercy South
Billing Code: 97760 (CPT)
- CPT Billing Code: 97760
- Insurance Median: $143
- Cash Discount Price: $105
- vs. Medicare Baseline: 3.10x 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 310% of the Medicare baseline (a markup of 210%). 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 | $41 - $147 | 89% |
| Blue Cross Blue Shield | $90 - $162 | 195% |
| Medicaid / KanCare | $99 | 215% |
| Cigna | $105 - $152 | 228% |
| Home State Health | $109 | 236% |
| Healthy Blue | $125 | 271% |
| Medica | $128 | 278% |
| Aetna | $131 - $149 | 284% |
| Orscheln | $142 | 308% |
| Nebraska Furniture Mart | $142 | 308% |
| Wppa Providrs Care | $142 | 308% |
| Wellfit/Centrus | $142 | 308% |
| Centivo | $142 | 308% |
| Quiktrip | $143 | 310% |
| Health Midwest Comprehensive Care | $143 | 310% |
| Humana | $146 | 317% |
| Coventry Health Care Of Kansas | $162 | 351% |
| Coxhealth Network | $162 | 351% |
| Mercy Health | $164 | 356% |
| Multiplan | $166 | 360% |
| American Healthcare Alliance | $186 | 404% |
| Healthlink | $193 | 419% |
| National Preferred Provider Network | $197 | 427% |
Consumer Guidance & Cost Commentary
For the CPT code 97760, "Orthotic fitting and training," Children's Mercy South in Overland Park, KS, lists a gross charge of $219.00. While the facility offers a cash median price of $105.00, which is significantly lower than the negotiated rates paid by major insurers like UnitedHealthcare (ranging from $41 to $147) and Blue Cross Blue Shield ($90 to $162), patients should be aware that commercial insurance rates often exceed cash prices. This occurs because insurance contracts include administrative overhead and risk premiums, sometimes resulting in a final allowed amount that is higher than the self-pay rate. For individuals with high-deductible plans, paying the cash price of $105.00 upfront may be more cost-effective than relying on insurance, provided the patient's deductible has not yet been met.
The facility's negotiated rate of $143.00 serves as a benchmark for in-network coverage, though the actual amount paid varies by payer. Notably, the cash price of $105.00 is roughly 23% lower than the facility's median negotiated rate of $143.00. Since Medicare benchmarks this service at $46.09, the cash price remains well above the federal baseline, reflecting the specific costs of orthotic services in this region. To minimize out-of-pocket expenses, patients are encouraged to contact the billing department directly to inquire about "self-pay" or "prompt-pay" discounts, which can further reduce the final balance before any insurance claim is processed.