CMS Price Transparency Data

Prosthetic fitting and training

Facility: Madison County Health Care System

Billing Code: 97761 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97761
Insurance Median: $77
Cash Discount Price: $69
vs. Medicare Baseline: 1.91x Medicare

The contracted insurance negotiated median rate for a Prosthetic fitting and training at Madison County Health Care System is $77. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $69. Compared to the federal Medicare reimbursement reference rate of $40.41, this hospital’s rate is 1.91x the Medicare baseline. Located in 300 West Hutchings Street, Winterset, IA.

Cash / Self-Pay

$69

Average discount available for prompt cash payment at this facility.

Insurance Median

$77

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: $69 (171%)

Insurance Median: $77 (191%)

Cash: $69 (171% of Medicare)

Ins. Median: $77 (191% 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	$37 - $56	92%
Medical Associates Hp - All Plans	$37	92%
Medigold-All Plans	$37	92%
Tricare	$37	92%
UnitedHealthcare	$37 - $77	92%
American Hp Mcr Adv-All Plans	$39	97%
Iowa Total Care Mcaid-All Plans	$40	99%
Molina Mcaid/Chip -All Plans	$42	104%
Amerigroup Mcaid-All Plans	$43	106%
Madison County Sheriff-All Plans	$43	106%
Oscar - All Plans	$55	136%
Corvel Wc-All Plans	$77	191%
Choicecare-All Plans	$82	203%
First Choice-All Plans	$82	203%
First Health-All Plans	$82	203%
Integrated Hp-All Plans	$82	203%
Mutual Of Omaha-All Plans	$82	203%
Plaines Health-All Plans	$82	203%
Preferred Hlth Ntwork-All Plans	$82	203%
Principal Healthcare-All Plans	$82	203%
Usa Managed Care-All Plans	$82	203%
Medimore Employee Hp - All Plans	$84	208%
Midlands Choice - All Plans	$84	208%
Benefit Admin Of America-All Plans	$86	213%
Blue Cross Blue Shield	$136 - $150	337%

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 $69.
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 Madison County Health Care System 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.