CMS Price Transparency Data

Prosthetic fitting and training

Facility: Cleveland Clinic Children's Hospital for Rehab

Billing Code: 97761 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97761
Insurance Median: $135
Cash Discount Price: $137
vs. Medicare Baseline: 3.34x Medicare

The contracted insurance negotiated median rate for a Prosthetic fitting and training at Cleveland Clinic Children's Hospital for Rehab is $135. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $137. Compared to the federal Medicare reimbursement reference rate of $40.41, this hospital’s rate is 3.34x the Medicare baseline. Located in 2801 Martin Luther King, Jr Drive, Cleveland, OH.

Cash / Self-Pay

$137

Average discount available for prompt cash payment at this facility.

Insurance Median

$135

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: $137 (339%)

Insurance Median: $135 (334%)

Cash: $137 (339% of Medicare)

Ins. Median: $135 (334% 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 334% of the Medicare baseline (a markup of 234%). 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
Oscar	$64 - $81	158%
Aultcare	$72	178%
Cigna	$91 - $169	225%
Amish Community Aid Plan	$95 - $106	235%
Ohcp	$103	255%
Summacare	$105 - $106	260%
Buckeye	$115 - $140	285%
Healthsmart	$116	287%
UnitedHealthcare	$117 - $155	290%
United	$121 - $132	299%
Paramount	$127	314%
Php	$127	314%
Phphi	$127	314%
The Health Plan	$127	314%
Upmc	$127	314%
Blue Cross Blue Shield	$130 - $160	322%
Molina	$130	322%
Caresource	$132	327%
Aetna	$135 - $211	334%
Amerihealth	$136	337%
Gms	$148	366%
Medical Benefit Corp	$148	366%
Quality Care Partners	$148	366%
Cc Ehp	$150	371%
Consociate Health	$158	391%
Ohio Healthy	$169	418%
Managed Care Services	$190	470%
Multiplan	$190	470%
Three Rivers	$190	470%

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 $137.
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 Cleveland Clinic Children's Hospital for Rehab 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.