CMS Price Transparency Data

Orthotic fitting and training

Facility: UPMC Kane

Billing Code: 97760 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97760
Insurance Median: $72
Cash Discount Price: $79
vs. Medicare Baseline: 1.56x Medicare

The contracted insurance negotiated median rate for a Orthotic fitting and training at UPMC Kane is $72. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $79. Compared to the federal Medicare reimbursement reference rate of $46.09, this hospital’s rate is 1.56x the Medicare baseline. Located in 4372 Route 6, Kane, PA.

Cash / Self-Pay

$79

Average discount available for prompt cash payment at this facility.

Insurance Median

$72

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: $79 (171%)

Insurance Median: $72 (156%)

Cash: $79 (171% of Medicare)

Ins. Median: $72 (156% 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
UPMC Health Plan	$32 - $168	69%
Blue Cross Blue Shield	$34 - $248	74%
Aetna	$35 - $71	76%
Highmark Wholecare (Prev Gateway)	$35 - $70	76%
UnitedHealthcare	$36 - $91	78%
Amerihealth Caritas	$37 - $74	80%
UPMC Work Partners	$50	108%
Geisinger	$51 - $102	111%
PA Health & Wellness	$51 - $102	111%
Focus Healthcare	$55 - $176	119%
Cigna	$64 - $4,165	139%
Horizon Health Plan	$64 - $130	139%
Multiplan	$69 - $139	150%
Health Coalition Partners	$74 - $148	161%
Intergroup	$74 - $148	161%

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 $79.
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 UPMC Kane 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.