CMS Price Transparency Data

Prosthetic fitting and training

Facility: Boone County Hospital

Billing Code: 97761 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97761
Insurance Median: $53
Cash Discount Price: $91
vs. Medicare Baseline: 1.31x Medicare

The contracted insurance negotiated median rate for a Prosthetic fitting and training at Boone County Hospital is $53. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $91. Compared to the federal Medicare reimbursement reference rate of $40.41, this hospital’s rate is 1.31x the Medicare baseline. Located in 1015 Union Street, Boone, IA.

Cash / Self-Pay

$91

Average discount available for prompt cash payment at this facility.

Insurance Median

$53

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: $91 (225%)

Insurance Median: $53 (131%)

Cash: $91 (225% of Medicare)

Ins. Median: $53 (131% 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
Tricare	$38	94%
Amerigroup Mcr Adv - All Other Plans	$47	116%
Choice Care Mcr Adv - All Plans	$47	116%
Humana	$47 - $103	116%
Iowa Hlth Adv - All Plans	$47	116%
Mt Carmel Hp - All Plans	$47	116%
UnitedHealthcare	$47 - $67	116%
Va Ccn-All Plans	$47	116%
Aetna	$48 - $60	119%
Meridian Mcaid - All Plans	$51	126%
Iowa Total Care Mcaid - All Plans	$52	129%
Medicaid / KanCare	$53	131%
Healthsmart Accell Network	$80	198%
Medical Associates Hp-All Plans	$86	213%
Healthsmart Ppo - All Other Plans	$91	225%
Health Alliance-All Plans	$103	255%
Midlands Choice-All Plans	$105	260%
Wellmark Hmo	$106	262%
Mutually Preferred-All Plans	$108	267%
Wellmark Ppo - All Other Plans	$116	287%

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 $91.
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 Boone County Hospital 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.