CMS Price Transparency Data

Prosthetic fitting and training

Facility: Atrium Health Navicent Rehabilitation Hopsital

Billing Code: 97761 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97761
Insurance Median: $51
Cash Discount Price: $74
vs. Medicare Baseline: 1.26x Medicare

The contracted insurance negotiated median rate for a Prosthetic fitting and training at Atrium Health Navicent Rehabilitation Hopsital is $51. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $74. Compared to the federal Medicare reimbursement reference rate of $40.41, this hospital’s rate is 1.26x the Medicare baseline. Located in 3351 Northside Dr, Macon, GA.

Cash / Self-Pay

$74

Average discount available for prompt cash payment at this facility.

Insurance Median

$51

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: $74 (183%)

Insurance Median: $51 (126%)

Cash: $74 (183% of Medicare)

Ins. Median: $51 (126% 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.

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
Aetna	$38 - $101	94%
Blue Cross Blue Shield	$38 - $70	94%
Care Source	$38	94%
Clover	$38	94%
Eon Health	$38	94%
Georgia Health Advantage	$38	94%
Humana	$38 - $101	94%
Pruitt Health	$38 - $40	94%
UnitedHealthcare	$38 - $294	94%
Cigna	$41 - $266	101%
Ambetter / Centene	$44 - $75	109%
Alliant	$45 - $65	111%
Securehealth	$51 - $68	126%
Kaiser	$60 - $96	148%
Multiplan	$96 - $118	238%
Ibg	$104	257%
Novanet	$118	292%
Three Rivers Provider Network	$125	309%
Beechstreet	$137	339%

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 $74.
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 Atrium Health Navicent Rehabilitation Hopsital 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.