CMS Price Transparency Data
Orthotic fitting and training
Facility: Mercy Health Saint Mary's
Billing Code: 97760 (CPT)
Factual Cost Summary (Answer Capsule)
- CPT Billing Code: 97760
- Insurance Median: $117
- Cash Discount Price: $104
- vs. Medicare Baseline: 2.54x Medicare
The contracted insurance negotiated median rate for a Orthotic fitting and training at Mercy Health Saint Mary's is $117. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $104. Compared to the federal Medicare reimbursement reference rate of $46.09, this hospital’s rate is 2.54x the Medicare baseline. Located in 200 Jefferson Avenue Se, Grand Rapids, MI.
Cash / Self-Pay
$104
Average discount available for prompt cash payment at this facility.
Insurance Median
$117
Median negotiated contract rate across all mapped commercial carriers.
Medicare Reference Rate
$46.09
Standard federal government reimbursement rate for this code.
Visual Cost Comparison vs. Medicare
Medicare Reference Baseline: $46.09 (100%)
Cash / Self-Pay: $104 (226%)
Insurance Median: $117 (254%)
Cash: $104 (226% of Medicare)
Ins. Median: $117 (254% of 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 254% of the Medicare baseline (a markup of 154%). 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.
Input your details and click calculate to compare out-of-pocket costs.
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 | $24 - $77 | 52% |
| Medicaid / KanCare | $24 | 52% |
| Access Health | $31 | 67% |
| Aetna | $43 - $100 | 93% |
| Blue Care Network Advantage | $43 | 93% |
| Medicare (plans) | $43 | 93% |
| Align Senior Care | $44 | 95% |
| Correctional Recovery | $44 | 95% |
| Hospice Faith | $44 | 95% |
| Hospice Of Holland | $44 | 95% |
| UnitedHealthcare | $45 - $160 | 98% |
| Longevity Ipa Of Michigan Llc Health Plan Isnp | $49 | 106% |
| Oscar | $56 | 122% |
| Molina Marketplace | $57 | 124% |
| Vitalcore | $68 | 148% |
| Wellpath | $68 | 148% |
| U Of M Health Plan | $70 - $122 | 152% |
| Bcn Domestic | $77 | 167% |
| Blue Benefit Administrators Of Massachusetts | $77 | 167% |
| Blue Care Network | $77 | 167% |
| Blue Distinction Transplant | $77 | 167% |
| Blue Shield - Ca | $77 | 167% |
| Blue Shield - Id (Regence) | $77 | 167% |
| Blue Shield - Ny Highmark Northeastern | $77 | 167% |
| Blue Shield - Ny Highmark Western | $77 | 167% |
| Blue Shield - Pa (Highmark) | $77 | 167% |
| Blue Shield - Wa (Regence) | $77 | 167% |
| Health Choices | $77 - $122 | 167% |
| Kaiser Domestic | $77 | 167% |
| Wc Accident Fund | $87 | 189% |
| Wc Advantage | $87 | 189% |
| Wc Aig | $87 | 189% |
| Wc Allied | $87 | 189% |
| Wc Amerisure | $87 | 189% |
| Wc Amtrust | $87 | 189% |
| Wc Asu Risk Mgt | $87 | 189% |
| Wc Berkley Admin | $87 | 189% |
| Wc Broadspire | $87 | 189% |
| Wc Bunch & Associates | $87 | 189% |
| Wc Ccmsi | $87 | 189% |
| Wc Emc Insurance Company | $87 | 189% |
| Wc Esis | $87 | 189% |
| Wc Fcci | $87 | 189% |
| Wc Federated | $87 | 189% |
| Wc Gallagher Bassett | $87 | 189% |
| Wc Genex Care For Ohio | $87 | 189% |
| Wc Guard Insurance Company | $87 | 189% |
| Wc Hartford | $87 | 189% |
| Wc Liberty Mutual | $87 | 189% |
| Wc Meijers | $87 | 189% |
| Wc Michigan | $87 | 189% |
| Wc Mitchell Frankenmuth | $87 | 189% |
| Wc Pma | $87 | 189% |
| Wc Sedgwick | $87 | 189% |
| Wc Sentry | $87 | 189% |
| Wc Travelers | $87 | 189% |
| Wc Tristar | $87 | 189% |
| Wc Walmart | $87 | 189% |
| Wc Zurich | $87 | 189% |
| Nomi Health | $90 | 195% |
| Acs Benefit Services | $92 | 200% |
| Allied Benefit Systems | $92 | 200% |
| Claimchoice Adminstrators | $92 | 200% |
| Consociate | $92 | 200% |
| Cypress Benefit Administrators | $92 | 200% |
| Forest County Potawatomi | $92 | 200% |
| Health Smart | $92 | 200% |
| Healthgram | $92 | 200% |
| Healthscope | $92 | 200% |
| Secureone Preferred United Plans | $92 | 200% |
| Sisco Benefits | $92 | 200% |
| The Health Plan | $92 | 200% |
| Trustmark Small Business Benefits | $92 | 200% |
| Unified Group Services | $92 | 200% |
| Webtpa | $92 | 200% |
| Priority Health | $95 - $97 | 206% |
| Geha | $100 - $122 | 217% |
| Medical Mutual | $100 | 217% |
| Meritain | $100 | 217% |
| Preferred One | $100 | 217% |
| Asr Health Benefits | $102 | 221% |
| Hap | $102 - $124 | 221% |
| Varipro | $104 | 226% |
| Caresource | $105 | 228% |
| 1199 National Benefit Fund | $117 | 254% |
| Allied National Global Care | $117 | 254% |
| Asrm - Reliance Standard Life Insurance | $117 | 254% |
| Christian Care Ministry | $117 | 254% |
| Cigna | $117 | 254% |
| Dean Health | $117 | 254% |
| Fallon Health | $117 | 254% |
| Family Life Insurance Company | $117 | 254% |
| Ghc Scw | $117 | 254% |
| Group Pension Administrators | $117 | 254% |
| International Benefit Administrators | $117 | 254% |
| Lifetime Benefit Solutions | $117 | 254% |
| Manhattan Life | $117 | 254% |
| Medi Share | $117 | 254% |
| Multiplan | $117 | 254% |
| Mvp | $117 | 254% |
| Pai | $117 | 254% |
| Pan-American Life | $117 | 254% |
| Paramount Hmo | $117 | 254% |
| Phcs | $117 | 254% |
| Trinity Health Share | $117 | 254% |
| Acclaim | $122 | 265% |
| Administrative Concepts | $122 | 265% |
| Allegeant | $122 | 265% |
| Ameriben | $122 | 265% |
| American Family | $122 | 265% |
| American Healthcare Alliance | $122 | 265% |
| American Republic | $122 | 265% |
| Amerihealth | $122 | 265% |
| Aultcare | $122 | 265% |
| Automated Benefit Services | $122 | 265% |
| Auxiant | $122 | 265% |
| Benefit Administrative Systems,Llc | $122 | 265% |
| Boon Chapman | $122 | 265% |
| Cam Administrative Services | $122 | 265% |
| Christian Brother Services | $122 | 265% |
| Christian Brothers Holy Cross | $122 | 265% |
| Comprehensive Benefits | $122 | 265% |
| Continental Life Insurance | $122 | 265% |
| Custom Benefit Administrators | $122 | 265% |
| Employee Benefit Concepts | $122 | 265% |
| Employee Benefit Management | $122 | 265% |
| Enterprise Group Planning | $122 | 265% |
| Freedom Life Insurance Company | $122 | 265% |
| Group Administrators | $122 | 265% |
| Group Marketing Services | $122 | 265% |
| Guardian | $122 | 265% |
| Health America | $122 | 265% |
| Healthez | $122 | 265% |
| Humana | $122 - $160 | 265% |
| Insight | $122 | 265% |
| Intercare | $122 | 265% |
| Jfp Benefit Management | $122 | 265% |
| Jp Farley Corporation | $122 | 265% |
| Key Benefit Administrator | $122 | 265% |
| Liberty Union Life Assurance Co | $122 | 265% |
| Lucent Health | $122 | 265% |
| Luminare Health | $122 | 265% |
| Luminare Health (Detroit) | $122 | 265% |
| Medben | $122 | 265% |
| Medcost | $122 | 265% |
| Mutual Health Services | $122 | 265% |
| Mutual Of Omaha | $122 | 265% |
| Ncas | $122 | 265% |
| Nippon Life Ins | $122 | 265% |
| Nova | $122 | 265% |
| Painters Union Insurance Fund | $122 | 265% |
| Physicians Mutual | $122 | 265% |
| Plumbers Local 98 Insurance Fund | $122 | 265% |
| Prairie States | $122 | 265% |
| Primary Physician Care | $122 | 265% |
| Professional Benefit Administrators | $122 | 265% |
| The Loomis Company | $122 | 265% |
| Unicare | $122 | 265% |
| Us Health And Life | $122 | 265% |
| Valenz | $122 | 265% |
| Western & Southern Financial Group | $122 | 265% |
| Wps | $122 | 265% |
| Coventry | $127 | 276% |
| First Health | $127 | 276% |
| Cmh Allegan County | $160 | 347% |
| Cmh Ausable Valley | $160 | 347% |
| Cmh Barry County | $160 | 347% |
| Cmh Berrien County | $160 | 347% |
| Cmh Cass County | $160 | 347% |
| Cmh Clinton-Eaton-Ingham County | $160 | 347% |
| Cmh Kalamazoo | $160 | 347% |
| Cmh Kent County | $160 | 347% |
| Cmh Lenawee County | $160 | 347% |
| Cmh Misc | $160 | 347% |
| Cmh Monroe County | $160 | 347% |
| Cmh Montcalm County | $160 | 347% |
| Cmh Muskegon County | $160 | 347% |
| Cmh Newaygo County | $160 | 347% |
| Cmh North Country | $160 | 347% |
| Cmh Northern Lakes County | $160 | 347% |
| Cmh Ottawa County | $160 | 347% |
| Cmh Van Buren County | $160 | 347% |
| Cmh West Mi County | $160 | 347% |
| Magellan Behavioral Health | $160 | 347% |