CMS Price Transparency Data

Orthotic fitting and training

Facility: Clarion Hospital

Billing Code: 97760 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97760
Insurance Median: $48
Cash Discount Price: $64
vs. Medicare Baseline: 1.04x Medicare

The contracted insurance negotiated median rate for a Orthotic fitting and training at Clarion Hospital is $48. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $64. Compared to the federal Medicare reimbursement reference rate of $46.09, this hospital’s rate is 1.04x the Medicare baseline. Located in One Hospital Drive, Clarion, PA.

Cash / Self-Pay

$64

Average discount available for prompt cash payment at this facility.

Insurance Median

$48

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: $64 (139%)

Insurance Median: $48 (104%)

Cash: $64 (139% of Medicare)

Ins. Median: $48 (104% 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.

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
Highmark	$39 - $73	85%
Highmark - Ind.& Managed Care	$39 - $98	85%
Martin'S Point - Usfhp	$40 - $44	87%
Upmc	$40 - $58	87%
Gateway	$43 - $47	93%
Amerihealth	$44	95%
Cigna	$44 - $58	95%
Highmark Community Blue	$44	95%
Medicare (plans)	$44	95%
Tricare	$44	95%
UnitedHealthcare	$44	95%
Aetna	$45 - $102	98%
Devoted Health Plan	$46	100%
Geisinger	$46	100%
The Health Plan	$46 - $103	100%
Pa Health & Wellness	$47	102%
American Health Plan	$48	104%
Workers Comp	$52	113%
Peak Health	$80 - $103	174%
Devon	$86	187%

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 $64.
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 Clarion Hospital 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.