CMS Price Transparency Data

Orthotic fitting and training

Facility: Penn State Health St. Joseph

Billing Code: 97760 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97760
Insurance Median: $64
Cash Discount Price: $74
vs. Medicare Baseline: 1.39x Medicare

The contracted insurance negotiated median rate for a Orthotic fitting and training at Penn State Health St. Joseph is $64. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $74. Compared to the federal Medicare reimbursement reference rate of $46.09, this hospital’s rate is 1.39x the Medicare baseline. Located in 2500 Bernville Road, Reading, PA.

Cash / Self-Pay

$74

Average discount available for prompt cash payment at this facility.

Insurance Median

$64

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: $74 (161%)

Insurance Median: $64 (139%)

Cash: $74 (161% of Medicare)

Ins. Median: $64 (139% 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
[Amerihealth Caritas]	$37 - $44	80%
[Highmark Wholecare]	$37 - $44	80%
[Geisinger]	$40 - $204	87%
[Health Partners Plans]	$41 - $45	89%
[Pa Health & Wellness]	$41 - $45	89%
[Highmark]	$43 - $166	93%
Aetna	$44 - $145	95%
Humana	$44	95%
UnitedHealthcare	$44 - $192	95%
[Cbc]	$44 - $150	95%
[Healthspring]	$44	95%
[Ibc]	$44 - $141	95%
[Upmc]	$45 - $209	98%
[Point Comfort Underwriters]	$55	119%
[Highmark Choice Blue]	$133	289%
[Highmark Aca]	$139	302%
Cigna	$174	378%
[Preferred Healthcare Systems]	$212	460%
[First Health]	$226	490%
[Multiplan]	$226	490%

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 $74.
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 Penn State Health St. Joseph 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.