CMS Price Transparency Data

Prosthetic fitting and training

Facility: Piedmont Macon North Hospital

Billing Code: 97761 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97761
Insurance Median: $187
Cash Discount Price: $62
vs. Medicare Baseline: 4.63x Medicare

The contracted insurance negotiated median rate for a Prosthetic fitting and training at Piedmont Macon North Hospital is $187. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $62. Compared to the federal Medicare reimbursement reference rate of $40.41, this hospital’s rate is 4.63x the Medicare baseline. Located in 400 Charter Boulevard, Macon, GA.

Cash / Self-Pay

$62

Average discount available for prompt cash payment at this facility.

Insurance Median

$187

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: $62 (153%)

Insurance Median: $187 (463%)

Cash: $62 (153% of Medicare)

Ins. Median: $187 (463% 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 463% of the Medicare baseline (a markup of 363%). 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
Medicaid / KanCare	$19 - $34	47%
Phcs [10601]	$125	309%
Industry Buying Group [10840]	$135	334%
First Health [10303]	$146	361%
Novanet [10819]	$156	386%
Beechstreet [10800]	$166	411%
Multiplan [10600]	$187	463%
Blue Cross Blue Shield	$194 - $208	480%
Aetna	$208	515%
Cigna	$208	515%
UnitedHealthcare	$208	515%

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 $62.
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 Piedmont Macon North Hospital 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.