CMS Price Transparency Data

Prosthetic fitting and training

Facility: Norton-King's Daughters' Health

Billing Code: 97761 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97761
Insurance Median: $89
Cash Discount Price: $25
vs. Medicare Baseline: 2.20x Medicare

The contracted insurance negotiated median rate for a Prosthetic fitting and training at Norton-King's Daughters' Health is $89. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $25. Compared to the federal Medicare reimbursement reference rate of $40.41, this hospital’s rate is 2.20x the Medicare baseline. Located in 1373 East Sr 62, Madison, IN.

Cash / Self-Pay

$25

Average discount available for prompt cash payment at this facility.

Insurance Median

$89

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: $25 (62%)

Insurance Median: $89 (220%)

Cash: $25 (62% of Medicare)

Ins. Median: $89 (220% 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 220% of the Medicare baseline (a markup of 120%). 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
Aetna	$25 - $100	62%
Blue Cross Blue Shield	$25 - $67	62%
Humana	$25 - $38	62%
Managed Health Services Of Kentucky	$25	62%
Passport By Molina	$25	62%
UnitedHealthcare	$38 - $89	94%
Managed Health Services	$40 - $60	99%
Caresource Of Kentucky	$54	134%
Custom Design Benefits	$57 - $77	141%
Caresource Of Indiana	$58	144%
Cigna	$97	240%
Encore	$97	240%
Quality Care Partners	$101	250%
Bluegrass	$103	255%
First Health	$103	255%
Healthlink	$103	255%
Vha/Tristate	$103	255%
Multiplan/Phcs	$105	260%
Indiana Health Network	$108	267%
Siho	$108	267%

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 $25.
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 Norton-King's Daughters' Health 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.