How many shoppable procedure prices are published for Merit Health Madison?

Merit Health Madison in Canton, MS currently has 111 standardized procedure price records indexed from its public 45 CFR § 180 machine-readable file.

How do Merit Health Madison's commercial prices compare to the fair BaseRate?

Across scored shoppable procedures, Merit Health Madison's median negotiated commercial rate is 1.3× the regionally adjusted fair BaseRate benchmark.

What is Merit Health Madison's CMS Care Compare overall star rating?

CMS Care Compare assigns Merit Health Madison an overall hospital quality rating of 3 out of 5 stars based on public federal clinical and patient-experience measures.

Hospital Profile Acute Care Hospital Proprietary 67 Beds · urban Updated: 4/1/2026

Merit Health Madison

161 River Oaks Drive, Canton, MS 39046 · 111 Priced Procedures · 73% Patient Recommendation

CMS Overall Rating 3 / 5 Stars

Above Fair Market · Negotiate

1.27×vs. Fair Market Price

Typical commercial prices here are +27% above the fair benchmark (1.27×) even after accounting for local nurse/doctor wages and patient complexity.

82/100 · Corroborated

82/100Self-Pay Cash Beats Insurance 41% of the Time

File Completeness61

Price Logic98

Peer Alignment70

Clean Billing83

Real Cash Discount100

Premium Quality Tier

4-Star CMS clinical quality rating paired with 1.27× fair market pricing.

Behavioral Pricing FingerprintHigh Insurer Rate · Deep Cash Discount

Cash-Arbitrage Bifurcated Pricer

Merit Health Madison maintains elevated commercial insurance contracts (1.27× Fair BaseRate) while offering direct self-pay cash discounts that beat commercial negotiated medians on 41% of procedures. High-deductible and uninsured patients should always request the self-pay cash rate prior to billing.

#41 of 65 in MS · 61st State Percentile#2,189 of 3,385 in U.S. · 64th National Percentile

Advantage

Where They're Good (Patient & Payer Edge)

Bottom-quartile procedures (Q25) price at 1.01× the peer BaseRate benchmark
Self-pay cash beats commercial insurance on 41% of shoppable procedures (99/100 Cash Honesty)
CMS clinical safety score (73/100 safety score) with 73% patient recommendation
Binding Good Faith Estimate rights under 45 CFR § 149.610 protect self-pay patients before scheduling

Watchout

Where You Can Get Burned (Markup Traps)

Even at low-cost facilities (1.27× Fair BaseRate), out-of-network or unnegotiated chargemaster bills can exceed commercial medians — confirm in-network status or request a self-pay cash quote up front.
Commercial insurance median sits at 1.31× Fair BaseRate (1.6× Medicare), so insured patients should always compare the self-pay cash price before paying.
Upper-quartile procedures (Q75 1.60×) jump +22% above the median procedure ratio (Q50 1.31×)
Consolidated metro market (HHI 2,330) limits in-network hospital competition (Moderately Concentrated (1,500–2,500))

Front-Door ShoppableElective / Imaging

1.6× Medicare

Pre-scheduled outpatient procedures where patients can comparison-shop.

Back-Door Captive & ER0.69× Divergence

1.1× Medicare

Emergency, inpatient DRG, lab, and specialty drug lines billed after admission.

Quantile Tail Spread+22% Upper Tail

Q25 1.01× · Q50 1.31× · Q75 1.60×

Detects median-gaming when upper-quartile codes spike above the p50 median.

Select any lens to inspect department markups, federal cost accounting, or insurer discounts.

Department & Integrity Multiples (vs. CMS Medicare Cost Anchor) Green ≤1.3× · Teal 1.3–1.8× · Amber 1.8–2.5× · Rose >2.5×

Front-Door Shoppable CareFront-Door Shoppable

1.6× MedicareGood

Outpatient Surgery & ORBack-Door Captive

0.7× MedicareGood

Diagnostic Imaging (CT/MRI)Front-Door Shoppable

1.7× MedicareGood

Back-Door Captive ER VisitsBack-Door Captive

3.5× MedicareElevated

Inpatient Lab & PathologyBack-Door Captive

3.7× MedicareElevated

Specialty & Infusion Drugs (J-Codes)Back-Door Captive

1.7× MedicareGood

Self-Pay Cash Honesty & 501(r)Integrity & Outcomes

41% Cash Edge · 99/100Good

CMS Clinical Safety & Star ValueIntegrity & Outcomes

3 CMS · 73/100Fair

Procedure Prices at Merit Health Madison

High-impact clinical procedures (MRIs, surgeries, inpatient stays, visits) are prioritized first. Use the category pills or search bar to filter all 111 published procedures.

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Audit a Bill & 501(r) Cap ↓

Procedure & Billing Code	Self-Pay Cash	This Hospital	Fair BaseRate	vs. Fair
Sepsis treatment (inpatient stay) MS-DRG Code: `871`	$20,257	$20,396	$19,087	1.1×
Digestive disorders treatment (inpatient stay) MS-DRG Code: `392`	$11,892	$8,186	$8,223	1.0×
Inguinal hernia repair CPT Code: `49505`	$3,687	$5,916	$3,629	1.6×
Breast lump removal CPT Code: `19120`	$3,632	$5,383	$3,875	1.4×
Trauma team activation HCPCS Code: `G0390`	$4,716	$2,185	$1,453	1.5×
Colonoscopy with biopsy CPT Code: `45380`	$1,102	$1,977	$1,256	1.6×
Sleep study (overnight, in lab) CPT Code: `95810`	$987	$1,706	$1,021	1.7×
Upper endoscopy with biopsy CPT Code: `43239`	$832	$1,572	$987	1.6×
Colonoscopy (diagnostic) CPT Code: `45378`	$832	$1,528	$981	1.6×
Echocardiogram (heart ultrasound) CPT Code: `93306`	$520	$940	$583	unverified
Blood transfusion CPT Code: `36430`	$396	$750	$498	1.5×
CT scan, abdomen and pelvis (with contrast) CPT Code: `74177`	$773	$612	$448	1.4×
MRI, brain (with and without contrast) CPT Code: `70553`	$773	$612	$511	1.2×
MRI, lower back (no contrast) CPT Code: `72148`	$747	$414	$338	1.2×
MRI, brain (no contrast) CPT Code: `70551`	$788	$414	$343	1.2×
MRI, knee or other leg joint CPT Code: `73721`	$788	$414	$369	1.1×
CT scan, abdomen and pelvis (no contrast) CPT Code: `74176`	$479	$414	$303	unverified
Ultrasound, leg veins (duplex) CPT Code: `93970`	$260	$414	$272	unverified
Hospital observation (per hour) HCPCS Code: `G0378`	$140	$350	$86	4.1×
Breathing treatment (nebulizer) CPT Code: `94640`	$192	$341	$201	unverified
CT scan, head (with contrast) CPT Code: `70460`	$600	$305	$242	1.3×
CT scan, head (with and without contrast) CPT Code: `70470`	$600	$305	$258	1.2×
Psychotherapy session (45 minutes) CPT Code: `90834`	$136	$275	$166	1.7×
Rabies immune globulin HCPCS Code: `90375`	$2,999	$291	$322	0.9×
Psychotherapy session (60 minutes) CPT Code: `90837`	$131	$316	$181	unverified
Family therapy session CPT Code: `90847`	$136	$275	$173	1.6×
Psychiatric evaluation (first visit) CPT Code: `90791`	$136	$275	$185	unverified
Care planning with family CPT Code: `90887`	$80	$200	$107	1.9×
Review of medical records for care CPT Code: `90889`	$80	$200	$114	1.8×
X-ray, pelvis CPT Code: `72170`	$390	$182	$110	1.7×
Ultrasound, pelvis CPT Code: `76856`	$399	$182	$130	1.4×
Ultrasound, thyroid and neck CPT Code: `76536`	$390	$182	$132	1.4×
CT scan, head (no contrast) CPT Code: `70450`	$439	$182	$160	1.1×
CT scan, pelvis CPT Code: `72192`	$600	$182	$163	1.1×
CT scan, sinuses CPT Code: `70486`	$439	$182	$166	1.1×
CT scan, lower back (lumbar spine) CPT Code: `72131`	$399	$182	$168	1.1×
CT scan, neck (cervical spine) CPT Code: `72125`	$439	$182	$169	1.1×
X-ray, lower back CPT Code: `72110`	$390	$182	$112	unverified
Ultrasound, abdomen (complete) CPT Code: `76700`	$399	$182	$134	unverified
Ultrasound, abdomen (limited) CPT Code: `76705`	$399	$182	$126	unverified
X-ray, chest (single view) CPT Code: `71045`	$83	$151	$92	1.6×
X-ray, shoulder CPT Code: `73030`	$83	$151	$92	1.6×
X-ray, foot CPT Code: `73630`	$83	$151	$92	1.6×
X-ray, neck (cervical spine) CPT Code: `72040`	$83	$151	$93	1.6×
X-ray, hand CPT Code: `73130`	$83	$151	$93	1.6×
X-ray, hip CPT Code: `73502`	$83	$151	$93	1.6×
X-ray, ankle CPT Code: `73610`	$83	$151	$93	1.6×
Hepatitis B immune globulin HCPCS Code: `90371`	$119	$139	$151	0.9×
Group therapy session CPT Code: `90853`	$76	$159	$100	unverified
Electrocardiogram (EKG, tracing only) CPT Code: `93005`	$64	$102	$64	1.6×
Speech therapy (language evaluation) CPT Code: `92507`	$73	$122	$86	1.4×
Office visit, established patient (20-29 min) CPT Code: `99213`	$98	$122	$87	1.4×
New patient office visit (30-44 min) CPT Code: `99203`	$114	$126	$110	1.1×
Office visit, established patient (30-39 min) CPT Code: `99214`	$132	$126	$123	1.0×
Diagnostic mammogram (both breasts) CPT Code: `77066`	$191	$130	$148	0.9×
X-ray, chest (two views) CPT Code: `71046`	$79	$151	$93	unverified
Orthotic fitting and training CPT Code: `97760`	$44	$82	$51	1.6×
Screening mammogram (both breasts) CPT Code: `77067`	$172	$107	$123	0.9×
CT scan, chest (no contrast) CPT Code: `71250`	$239	$100	$167	0.6×
Typhoid vaccine HCPCS Code: `90675`	$586	$339	$347	1.0×
MMR vaccine (measles, mumps, rubella) HCPCS Code: `90707`	$141	$141	$111	1.3×
Drug screening test HCPCS Code: `G0480`	$69	$119	$116	1.0×
Pneumococcal vaccine HCPCS Code: `90732`	$108	$138	$140	1.0×
Varicella (chickenpox) vaccine HCPCS Code: `90716`	$162	$121	$203	0.6×
Tdap vaccine (tetanus, diphtheria, pertussis) HCPCS Code: `90715`	$72	$72	$56	1.3×
Blood antibody screen CPT Code: `86850`	$51	$90	$46	unverified
Electrical stimulation therapy HCPCS Code: `G0283`	$24	$29	$14	2.1×
Speech therapy (group session) CPT Code: `92508`	$22	$44	$27	1.6×
Physical therapy (neuromuscular re-education) CPT Code: `97112`	$32	$59	$38	1.6×
Hepatitis B vaccine HCPCS Code: `90744`	$55	$57	$37	1.5×
Physical therapy (manual therapy) CPT Code: `97140`	$26	$50	$34	1.5×
Flu vaccine (high dose) HCPCS Code: `90656`	$30	$31	$25	1.2×
DTaP vaccine (diphtheria, tetanus, pertussis) HCPCS Code: `90700`	$44	$44	$39	1.1×
Physical therapy (therapeutic exercise) CPT Code: `97110`	$28	$53	$35	unverified
Physical therapy (gait training) CPT Code: `97116`	$28	$53	$33	unverified
Occupational therapy (therapeutic activities) CPT Code: `97530`	$34	$63	$40	unverified
Occupational therapy (self-care training) CPT Code: `97535`	$31	$60	$38	unverified
Physical therapy (functional capacity test) CPT Code: `97750`	$31	$60	$38	unverified
Prosthetic fitting and training CPT Code: `97761`	$38	$73	$45	unverified
Flu vaccine injection HCPCS Code: `G0008`	$40	$85	$48	unverified
Pneumonia vaccine injection HCPCS Code: `G0009`	$40	$85	$49	unverified
Colorectal cancer screening HCPCS Code: `G0010`	$40	$85	$49	unverified
Blood test, basic metabolic panel CPT Code: `80048`	$177	$9	$9	1.0×
Blood test, comprehensive metabolic panel CPT Code: `80053`	$106	$11	$11	1.0×
Blood test, cholesterol (lipid panel) CPT Code: `80061`	$42	$14	$14	1.0×
Blood test, liver function panel CPT Code: `80076`	$72	$9	$9	1.0×
Blood test, vitamin D CPT Code: `82306`	$47	$31	$31	1.0×
Urinalysis (automated, with microscopy) CPT Code: `81001`	$44	$3	$3	1.0×
Blood test, amylase CPT Code: `82150`	$42	$7	$7	1.0×
Blood test, calcium CPT Code: `82310`	$27	$5	$5	1.0×
Blood test, creatinine (kidney) CPT Code: `82565`	$10	$5	$5	1.0×
Blood test, vitamin B12 CPT Code: `82607`	$50	$16	$16	1.0×
Blood test, ferritin (iron stores) CPT Code: `82728`	$65	$14	$14	1.0×
Blood test, glucose (blood sugar) CPT Code: `82947`	$24	$4	$4	1.0×
Blood test, average blood sugar (A1c) CPT Code: `83036`	$10	$10	$10	1.0×
Blood test, lipase CPT Code: `83690`	$45	$7	$7	1.0×
Blood test, magnesium CPT Code: `83735`	$85	$7	$7	1.0×
Blood test, potassium CPT Code: `84132`	$27	$5	$5	1.0×
Blood test, PSA (prostate screen) CPT Code: `84153`	$68	$19	$19	1.0×
Blood test, sodium CPT Code: `84295`	$34	$5	$5	1.0×
Blood test, urea nitrogen (BUN, kidney) CPT Code: `84520`	$25	$4	$4	1.0×
Blood test, complete blood count (CBC) CPT Code: `85025`	$52	$8	$8	1.0×
Blood test, clotting time (PTT) CPT Code: `85730`	$60	$6	$6	1.0×
Hepatitis C antibody test CPT Code: `86803`	$64	$15	$15	1.0×
Culture, blood CPT Code: `87040`	$120	$11	$11	1.0×
Culture, bacterial CPT Code: `87070`	$72	$9	$9	1.0×
Prostate cancer screening (blood test) HCPCS Code: `G0103`	$47	$20	$20	1.0×
Blood test, thyroid (TSH) CPT Code: `84443`	$71	$17	$18	0.9×
Blood test, clotting time (PT/INR) CPT Code: `85610`	$32	$4	$5	0.8×
Blood test, hemoglobin CPT Code: `85018`	$10	$2	$3	0.7×
Diagnostic procedure preparation HCPCS Code: `G0279`	$31	$22	$35	0.6×

Showing top 25 high-impact procedures of 111 total

Inline Bill X-Ray & 501(r) Calculator For-Profit Facility · Cash & Fair BaseRate Audit

Audit a Bill or Quote at Merit Health Madison (Zero PHI Required)

CMS CCN: 250038

CPT 871

Select Procedure to Audit:

Fair BaseRate™ $19,087

Medicare Rate $14,117

Self-Pay Cash $20,257

Insurer Median $20,396

1. Amount on Your Bill or Quote ($) Pre-filled with Merit Health Madison’s charged/list benchmark

2. Household Annual Income ($) Screened against 2026 HHS Federal Poverty Guidelines

3. Household Size (1–8) 2026 FPL: $15,650 + $5,500 per additional person

Step 1 · 501(r) Charity Care Check 274% of 2026 FPL

Above Standard 400% FPL Financial-Assistance Ceiling

At 274% FPL, you exceed the standard 400% FPL tier, though medical-hardship caps (when bills exceed 10% of annual income) may still apply.

Step 2 · Cash vs. Insurance Arbitrage Save $30,386 Paying Cash

Self-Pay Cash Rate ($20,257) Beats Your Bill

Merit Health Madison's published 45 CFR § 180 self-pay cash rate is $20,257 (vs. $20,396 commercial insurer median). Ask billing to reclassify the visit to prompt-pay self-pay if it beats your deductible.

Step 3 · Fair BaseRate Target +$31,556 Above Fair BaseRate

Negotiate Toward $19,087 Fair BaseRate ($14,117 Medicare)

Your bill ($50,643) is $31,556 above the denoised Fair BaseRate ($19,087) and 3.6× the $14,117 Medicare rate.

1-Click Factual Dispute Summary: Copy a citation-backed benchmark memo (with CMS CCN, CPT code, Medicare reference, Fair BaseRate, and 26 U.S.C. § 501(r) calculations) to paste into patient-portal messages or billing appeals.

IRS Form 990 Schedule H & 26 U.S.C. § 501(r) For-Profit / Non-501(c)(3)

Financial Assistance Policy (FAP) & Amounts Generally Billed (AGB)

Public IRS & CMS ownership records classify Merit Health Madison as a non-501(c)(3) facility. Federal 26 U.S.C. § 501(r) statutory charity-care caps apply specifically to tax-exempt nonprofit hospitals, though state hospital fair-pricing statutes and prompt-pay self-pay discounts may still apply.

Screen your household size, income, and itemized CPT codes against 2026 HHS Federal Poverty Guidelines: Calculate Your 501(r) Cap Above ↑

CMS Care Compare Public Quality Record

Clinical Quality, Patient Experience & Infection Benchmarks

CMS Overall4/5 Stars (4/5)

Safety Composite73/100

Would Recommend73%

Rated 9 or 10 (HCAHPS)74%

Median ER Wait127 min

Left ER Before Seen2%

30-Day Mortality vs U.S.same

Unplanned Readmissionsame

Healthcare-Associated Infections (CDC NHSN / CMS HAI)

1.00 SIR = National Predicted Baseline (Lower Is Safer)

C. diff Hospital-Onset Infectionsame

CMS Price Transparency Administrative Enforcement Log

Factual public administrative actions published by the Centers for Medicare & Medicaid Services regarding 45 CFR § 180 compliance at Merit Health Madison. Prior administrative notices do not necessarily reflect current compliance status.

2025-04-17·administrative_or_closure
Met Requirements
Recorded

Source: CMS Hospital Care Compare (137 completed HCAHPS patient surveys). Clinical quality metrics summarize historical facility-wide cohorts and are not medical advice for individual care decisions.

Care-Setting Arbitrage, Bilateral SVD Insurer Leverage & Regional Alternatives

How to Pay Less Nearby: Freestanding Centers, Insurer Leverage & Outpatient Savings

Higher-Quality, Above-Median Price Tier

2D regional comparison of commercial negotiated price index against CMS clinical quality composite for Merit Health Madison.

Price Index: 1.01× regional baseline

Quality: 68/100 CMS composite

Median Household Income$78,794U.S. Census ACS

Local Uninsured Share8.4%Regional ACS estimate

200% FPL (1 Person)$31,920Common free-care ceiling

400% FPL (Family of 4)$128,600Common AGB cap ceiling

45 CFR § 180 Primary-Source Lineage & Federal Verification VeriRate 82/100 · Corroborated CMS CCN 250038

Verify the Raw Data: Official Hospital MRF, CMS Medicare.gov & Federal Filings

MRF Portal Indexed (CMS_45_CFR_180_FILING.json) Verify on CMS Medicare.gov (CCN 250038) ↗ CMS HCRIS Cost Reports ↗

Published MRF FileCMS_45_CFR_180_FILING.json

Publication / Vintage4/1/2026

Validated Rate Rows2,119 (CMS v3.0.0)

File Integrity DigestVerified · CCN 250038

Safe-Harbor Data Corrections: Parsed directly from public 45 CFR § 180 hospital filings, CMS Care Compare, and CMS HCRIS cost reports. Hospital compliance officers may submit updated MRF URLs or rate tables for verification.

Submit MRF Update Correction Policy