CMS Price Transparency Data

Prosthetic fitting and training

Facility: Iowa Specialty Hospital - Clarion

Billing Code: 97761 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97761
Insurance Median: $98
Cash Discount Price: $86
vs. Medicare Baseline: 2.43x Medicare

The contracted insurance negotiated median rate for a Prosthetic fitting and training at Iowa Specialty Hospital - Clarion is $98. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $86. Compared to the federal Medicare reimbursement reference rate of $40.41, this hospital’s rate is 2.43x the Medicare baseline. Located in 1316 South Main Street, Clarion, IA.

Cash / Self-Pay

$86

Average discount available for prompt cash payment at this facility.

Insurance Median

$98

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: $86 (213%)

Insurance Median: $98 (243%)

Cash: $86 (213% of Medicare)

Ins. Median: $98 (243% 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 243% of the Medicare baseline (a markup of 143%). 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
Tricare	$31 - $57	77%
Triwest Va - All Plans	$31 - $57	77%
Healthscope Stellar-All Plans	$53 - $97	131%
Auxiant Clarion Schools-All Plans	$66 - $120	163%
Health Partners Prestage	$76 - $138	188%
Health Partners Ish-All Other Plans	$81 - $147	200%
Aetna	$86 - $156	213%
UnitedHealthcare	$96 - $175	238%
Cigna	$98 - $178	243%
Midlands Choice-All Plans	$98 - $178	243%
Wellmark Hmo	$158	391%
Wellmark Ppo - All Other Plans	$174	431%

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 $86.
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 Iowa Specialty Hospital - Clarion 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.