CMS Price Transparency Data

Orthotic fitting and training

Facility: John Heinz Institute of Rehabilitation Medicine

Billing Code: 97760 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97760
Insurance Median: $44
Cash Discount Price: Unavailable
vs. Medicare Baseline: 0.95x Medicare

The contracted insurance negotiated median rate for a Orthotic fitting and training at John Heinz Institute of Rehabilitation Medicine is $44. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is unavailable. Compared to the federal Medicare reimbursement reference rate of $46.09, this hospital’s rate is 0.95x the Medicare baseline. Located in 150 Mundy St, Wilkes Barre, PA.

Cash / Self-Pay

Unavailable

Average discount available for prompt cash payment at this facility.

Insurance Median

$44

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%)

Insurance Median: $44 (95%)

Ins. Median: $44 (95% 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
Freedom Blue Claims	$35	76%
Highmark	$35 - $52	76%
Aetna	$44 - $46	95%
Amerihealth Caritas Vip Care	$44	95%
Humana	$44	95%
PA Health and Wellness Allwell	$44	95%
UPMC for Life	$44	95%
UPMC	$50	108%
First Priority Health	$65	141%

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 $X.
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 John Heinz Institute of Rehabilitation Medicine 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.