CMS Price Transparency Data

New patient office visit (30-44 min)

Facility: Boone County Hospital

Billing Code: 99203 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 99203
Insurance Median: $93
Cash Discount Price: $166
vs. Medicare Baseline: 0.79x Medicare

The contracted insurance negotiated median rate for a New patient office visit (30-44 min) at Boone County Hospital is $93. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $166. Compared to the federal Medicare reimbursement reference rate of $117.57, this hospital’s rate is 0.79x the Medicare baseline. Located in 1015 Union Street, Boone, IA.

Cash / Self-Pay

$166

Average discount available for prompt cash payment at this facility.

Insurance Median

$93

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$117.57

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $117.57 (100%)

Cash / Self-Pay: $166 (141%)

Insurance Median: $93 (79%)

Cash: $166 (141% of Medicare)

Ins. Median: $93 (79% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $117.57 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
Amerigroup Mcr Adv - All Other Plans	$42 - $83	36%
Choice Care Mcr Adv - All Plans	$42 - $82	36%
Humana	$42 - $297	36%
Iowa Hlth Adv - All Plans	$42 - $82	36%
Mt Carmel Hp - All Plans	$42 - $82	36%
UnitedHealthcare	$42 - $117	36%
Va Ccn-All Plans	$42 - $82	36%
Aetna	$43 - $156	37%
Meridian Mcaid - All Plans	$46 - $330	39%
Iowa Total Care Mcaid - All Plans	$47 - $337	40%
Medicaid / KanCare	$47 - $340	40%
Tricare	$61 - $132	52%
Healthsmart Accell Network	$71 - $140	60%
Healthsmart Ppo - All Other Plans	$74 - $160	63%
Medical Associates Hp-All Plans	$76 - $150	65%
Health Alliance-All Plans	$81 - $180	69%
Midlands Choice-All Plans	$94 - $184	80%
Mutually Preferred-All Plans	$97 - $314	83%
Wellmark Hmo	$117	100%
Wellmark Ppo - All Other Plans	$117	100%
Health Partners Profee Only - All Plans	$133	113%

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 $166.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 99203.

Insurance In-Network Protection Plan

Contact your insurance company to confirm Boone County Hospital is fully in-network.
Ask your insurer if "Prior Authorization" is required for CPT code 99203.
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.