CMS Price Transparency Data

Orthotic fitting and training

Facility: Mercy Hospital Washington

Billing Code: 97760 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97760
Insurance Median: $112
Cash Discount Price: $89
vs. Medicare Baseline: 2.43x Medicare

The contracted insurance negotiated median rate for a Orthotic fitting and training at Mercy Hospital Washington is $112. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $89. Compared to the federal Medicare reimbursement reference rate of $46.09, this hospital’s rate is 2.43x the Medicare baseline. Located in 901 East 5Th Street, Washington, MO.

Cash / Self-Pay

$89

Average discount available for prompt cash payment at this facility.

Insurance Median

$112

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: $89 (193%)

Insurance Median: $112 (243%)

Cash: $89 (193% of Medicare)

Ins. Median: $112 (243% 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 243% of the Medicare baseline (a markup of 143%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.

Consult Patient Advocate

Out-of-Pocket Cost Estimator

Estimate whether it is more economical to use your insurance or pay the upfront self-pay cash rate.

Billing Status

Remaining Deductible ($)

Your Coinsurance 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
Medicaid / KanCare	$6 - $145	13%
Aetna	$13 - $184	28%
Cigna	$40 - $198	87%
American Health Advantage Of Mo Mcr [10473]	$41	89%
Blue Cross Blue Shield	$41 - $274	89%
Cherokee Nation Health Serv Contracted [320066]	$41	89%
Cross Timbers Hospice [20098]	$41	89%
Dept Of Veteran Affairs Contracted [320106]	$41	89%
Elara Caring Aspire Hospice Contracted [320433]	$41	89%
Elara Caring Aspire Hospice [20433]	$41	89%
Globalhealth Contracted [320145]	$41	89%
Halo Hcr Inc Hospice Contracted [320432]	$41	89%
Halo Hcr Inc Hospice [20432]	$41	89%
Humana	$41	89%
Kindful Hospice Contracted [320434]	$41	89%
Kindful Hospice [20434]	$41	89%
Medicare (plans)	$41 - $187	89%
Mercy Hospice Okc [20252]	$41	89%
Pace Of The Ozarks Contracted [320518]	$41	89%
Qual Choice Contracted [320325]	$41	89%
Tricare	$41	89%
UnitedHealthcare	$41 - $193	89%
Provider Partners Health Plans Contracted [320450]	$45	98%
Healthscope Contracted [320182]	$51	111%
Health Choices Contracted [320448]	$53 - $112	115%
Health Choices [20448]	$53 - $112	115%
Medical Associates Health Contracted [320444]	$53 - $112	115%
Federal Medical Center Contracted [320127]	$57 - $122	124%
Insurance System Inc Contracted [320465]	$57 - $122	124%
Point C Contracted [320238]	$57 - $122	124%
Tri State Healthcare Coalition Contracted [320379]	$57 - $122	124%
Healthlink Contracted [320179]	$60 - $225	130%
First Health Contracted [320128]	$62 - $133	135%
Mercy Mgd Behavioral Health Contracted [320259]	$62 - $131	135%
Multiplan Contracted [320270]	$62 - $140	135%
Private Health Care Systems Contracted [320320]	$62 - $131	135%
Workers Comp [20426]	$66 - $150	143%
Centivo Contracted [320505]	$69	150%
Preferred Health Plan Contracted [320522]	$73	158%
Hope Trust Contracted [320488]	$100	217%
Medica Contracted [320239]	$137	297%
Ambetter / Centene	$145	315%
Home State Health Plan Contracted [320187]	$145	315%
Novasys Contracted [320285]	$145	315%
Mercy Benefit Admin Contracted [320251]	$170 - $209	369%
Mercy Benefit Admin [20251]	$170 - $209	369%
United Medical Resources Contracted [320454]	$193	419%
Show-Me Health Administrators Contracted [320483]	$203 - $213	440%
Aither Health Contracted [320449]	$209	453%
Aither Health [20449]	$209	453%
Auxiant Contracted [320462]	$209	453%
Ebms Contracted [320493]	$209	453%
Edison Health Solutions Contracted [320502]	$209	453%
Imagine 360 Contracted [320494]	$209	453%
Reflect Health Contracted [320492]	$209	453%
Yuzu Health Contracted [320521]	$209	453%

Self-Pay Upfront Cash Action Plan

Request a "Self-Pay classification" with the billing desk before receiving care.
Ask for a written "Prompt-Pay Discount" agreement quoting the price of $89.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 97760.

Insurance In-Network Protection Plan

Contact your insurance company to confirm Mercy Hospital Washington is fully in-network.
Ask your insurer if "Prior Authorization" is required for CPT code 97760.
Confirm the specific physician or imaging center is also in-network (not just the hospital building).
Audit your Explanation of Benefits (EOB) against the final itemized hospital invoice.