CMS Price Transparency Data

Prosthetic fitting and training

Facility: Mercyone Waterloo Medical Center

Billing Code: 97761 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97761
Insurance Median: $111
Cash Discount Price: $102
vs. Medicare Baseline: 2.75x Medicare

The contracted insurance negotiated median rate for a Prosthetic fitting and training at Mercyone Waterloo Medical Center is $111. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $102. Compared to the federal Medicare reimbursement reference rate of $40.41, this hospital’s rate is 2.75x the Medicare baseline. Located in 3421 West Ninth Street, Waterloo, IA.

Cash / Self-Pay

$102

Average discount available for prompt cash payment at this facility.

Insurance Median

$111

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: $102 (252%)

Insurance Median: $111 (275%)

Cash: $102 (252% of Medicare)

Ins. Median: $111 (275% 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 275% of the Medicare baseline (a markup of 175%). 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
Iowa Total Care	$25	62%
Medicaid / KanCare	$25	62%
Health Choices	$37	92%
Medical Associates	$37	92%
Aetna	$38 - $302	94%
Amish Hospital Aid	$38	94%
Blue Cross Blue Shield	$38	94%
Medicare (plans)	$38 - $39	94%
UnitedHealthcare	$38 - $231	94%
Oscar	$59	146%
Centivo	$64	158%
Ambetter / Centene	$65	161%
Claimdoc	$77	191%
Nova	$77	191%
Health Partners	$103	255%
Auxiant	$111	275%
Cigna	$111	275%
Medica	$111	275%
Midlands	$111	275%
Midlands Choice	$111	275%
Iowa Dept Of Public Health	$157	389%
Geha	$231	572%
Allied Benefit Systems	$302	747%
Asr Health Benefits	$302	747%
Christian Brother Services	$302	747%
Coventry	$302	747%
First Health	$302	747%
Lucent Health	$302	747%
Luminare Health	$302	747%
Medical Mutual	$302	747%
Meritain	$302	747%
Webtpa	$302	747%

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 $102.
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 Mercyone Waterloo Medical Center 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.