CMS Price Transparency Data

Prosthetic fitting and training

Facility: Merit Health Madison

Billing Code: 97761 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97761
Insurance Median: $70
Cash Discount Price: $38
vs. Medicare Baseline: 1.73x Medicare

The contracted insurance negotiated median rate for a Prosthetic fitting and training at Merit Health Madison is $70. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $38. Compared to the federal Medicare reimbursement reference rate of $40.41, this hospital’s rate is 1.73x the Medicare baseline. Located in 161 River Oaks Drive, Canton, MS.

Cash / Self-Pay

$38

Average discount available for prompt cash payment at this facility.

Insurance Median

$70

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: $38 (94%)

Insurance Median: $70 (173%)

Cash: $38 (94% of Medicare)

Ins. Median: $70 (173% 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
Blue Cross Blue Shield	$33	82%
Ms-Can-Magnolia	$34	84%
Ms-Can-Molina	$34	84%
Advhealth	$35	87%
Ms-Can-Truecare	$35	87%
Medicare (plans)	$37	92%
Wellcare	$38	94%
Devoted_Health	$39	97%
Humana	$39	97%
Mpcn	$70	173%
Molina-Chip	$73	181%
Firstchoice	$74	183%
Magnolia-Chip	$75	186%
Truecare-Chip	$75	186%
Molina_Exchange	$80	198%
Ambetter / Centene	$93	230%
Cigna	$96	238%
United	$96	238%
United_Exchange	$96	238%

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 $38.
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 Merit Health Madison 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.