CMS Price Transparency Data

Prosthetic fitting and training

Facility: Mercy St Francis Hospital

Billing Code: 97761 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97761
Insurance Median: $101
Cash Discount Price: $73
vs. Medicare Baseline: 2.50x Medicare

The contracted insurance negotiated median rate for a Prosthetic fitting and training at Mercy St Francis Hospital is $101. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $73. Compared to the federal Medicare reimbursement reference rate of $40.41, this hospital’s rate is 2.50x the Medicare baseline. Located in 100 West Highway 60, Po Box 82, Mountain View, MO.

Cash / Self-Pay

$73

Average discount available for prompt cash payment at this facility.

Insurance Median

$101

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$40.41

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $40.41 (100%)

Cash / Self-Pay: $73 (181%)

Insurance Median: $101 (250%)

Cash: $73 (181% of Medicare)

Ins. Median: $101 (250% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $40.41 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 250% of the Medicare baseline (a markup of 150%). 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	$20 - $58	49%
Elara Caring Aspire Hospice [20433]	$31 - $38	77%
Mercy Hospice Okc [20252]	$31 - $38	77%
Halo Hcr Inc Hospice [20432]	$31 - $38	77%
Cherokee Nation Health Serv Contracted [320066]	$31 - $38	77%
Medicare (plans)	$31 - $40	77%
Blue Cross Blue Shield	$31 - $109	77%
Medical Associates Health Contracted [320444]	$31 - $38	77%
Cross Timbers Hospice [20098]	$31 - $38	77%
Humana	$31 - $101	77%
Globalhealth Contracted [320145]	$31 - $38	77%
Halo Hcr Inc Hospice Contracted [320432]	$31 - $38	77%
Indian Health Service Contracted [320198]	$31 - $38	77%
Aetna	$31 - $100	77%
Cigna	$31 - $106	77%
Pace of the Ozarks Contracted [320518]	$31 - $38	77%
UnitedHealthcare	$31 - $106	77%
Provider Partners Health Plans Contracted [320450]	$31 - $38	77%
Qual Choice Contracted [320325]	$31 - $38	77%
Acentra Health Contracted [320527]	$31	77%
Mercy Mgd Behavioral Health Contracted [320259]	$31 - $38	77%
Kindful Hospice [20434]	$31 - $38	77%
Kindful Hospice Contracted [320434]	$31 - $38	77%
Dept of Veteran Affairs Contracted [320106]	$31 - $38	77%
Healthscope Contracted [320182]	$38 - $51	94%
Tricare	$38	94%
Administrative Payor Contracted [320005]	$50	124%
Centivo Contracted [320505]	$51 - $65	126%
Home State Health Plan Contracted [320187]	$58	144%
Ambetter / Centene	$58	144%
Novasys Contracted [320285]	$58	144%
Healthlink Contracted [320179]	$73 - $106	181%
Preferred Health Plan Contracted [320522]	$73	181%
Workers Comp [20426]	$90 - $95	223%
United Medical Resources Contracted [320454]	$101 - $104	250%
Mercy Benefit Admin Contracted [320251]	$101 - $106	250%
Auxiant Contracted [320462]	$101 - $106	250%
Point C Contracted [320238]	$101 - $106	250%
Health Systems Inc Contracted [320174]	$106	262%
Yuzu Health Contracted [320521]	$106	262%
Multiplan Contracted [320270]	$106	262%
Medica Contracted [320239]	$106	262%
Show-Me Health Administrators Contracted [320483]	$106	262%
Edison Health Solutions Contracted [320502]	$106	262%
Reflect Health Contracted [320492]	$106	262%
Evolutions Health Care Contracted [320124]	$106	262%
Benefit Management Contracted [320052]	$106	262%
USA Managed Care Org Contracted [320429]	$106	262%
Insurance System Inc Contracted [320465]	$106	262%
Ebms Contracted [320493]	$106	262%
Private Health Care Systems Contracted [320320]	$106	262%
Aither Health Contracted [320449]	$106	262%
Imagine 360 Contracted [320494]	$106	262%
First Health Contracted [320128]	$106	262%
Point C [20238]	$106	262%
90 Degree Benefits Contracted [320436]	$106	262%

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 $73.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 97761.

Insurance In-Network Protection Plan

Contact your insurance company to confirm Mercy St Francis Hospital is fully in-network.
Ask your insurer if "Prior Authorization" is required for CPT code 97761.
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.