CMS Price Transparency Data

Office visit, established patient (20-29 min)

Facility: Boone County Hospital

Billing Code: 99213 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 99213
Insurance Median: $83
Cash Discount Price: $128
vs. Medicare Baseline: 0.87x Medicare

The contracted insurance negotiated median rate for a Office visit, established patient (20-29 min) at Boone County Hospital is $83. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $128. Compared to the federal Medicare reimbursement reference rate of $95.19, this hospital’s rate is 0.87x the Medicare baseline. Located in 1015 Union Street, Boone, IA.

Cash / Self-Pay

$128

Average discount available for prompt cash payment at this facility.

Insurance Median

$83

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$95.19

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $95.19 (100%)

Cash / Self-Pay: $128 (134%)

Insurance Median: $83 (87%)

Cash: $128 (134% of Medicare)

Ins. Median: $83 (87% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $95.19 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	$29 - $83	30%
Choice Care Mcr Adv - All Plans	$29 - $82	30%
Humana	$29 - $238	30%
Iowa Hlth Adv - All Plans	$29 - $82	30%
Mt Carmel Hp - All Plans	$29 - $82	30%
UnitedHealthcare	$29 - $117	30%
Va Ccn-All Plans	$29 - $82	30%
Aetna	$30 - $156	32%
Iowa Total Care Mcaid - All Plans	$32 - $269	34%
Meridian Mcaid - All Plans	$32 - $264	34%
Medicaid / KanCare	$33 - $272	35%
Tricare	$42 - $106	44%
Healthsmart Accell Network	$49 - $140	51%
Medical Associates Hp-All Plans	$53 - $150	56%
Healthsmart Ppo - All Other Plans	$56 - $160	59%
Health Alliance-All Plans	$63 - $180	66%
Midlands Choice-All Plans	$65 - $184	68%
Mutually Preferred-All Plans	$67 - $251	70%
Health Partners Profee Only - All Plans	$87	91%
Wellmark Hmo	$93	98%
Wellmark Ppo - All Other Plans	$93	98%

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 $128.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 99213.

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 99213.
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.