CMS Price Transparency Data

Digestive disorders treatment (inpatient stay)

Facility: Boone County Hospital

Billing Code: 392 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 392
Insurance Median: $10,010
Cash Discount Price: $10,010
vs. Medicare Baseline: 1.76x Medicare

The contracted insurance negotiated median rate for a Digestive disorders treatment (inpatient stay) at Boone County Hospital is $10,010. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $10,010. Compared to the federal Medicare reimbursement reference rate of $5,675.87, this hospital’s rate is 1.76x the Medicare baseline. Located in 1015 Union Street, Boone, IA.

Cash / Self-Pay

$10,010

Average discount available for prompt cash payment at this facility.

Insurance Median

$10,010

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$5,675.87

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $5,675.87 (100%)

Cash / Self-Pay: $10,010 (176%)

Insurance Median: $10,010 (176%)

Cash: $10,010 (176% of Medicare)

Ins. Median: $10,010 (176% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $5,675.87 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	$5,223	92%
Wellmark Hmo	$6,632	117%
Wellmark Ppo - All Other Plans	$6,632	117%
UnitedHealthcare	$7,345	129%
Healthsmart Accell Network	$8,759	154%
Medical Associates Hp-All Plans	$9,384	165%
Aetna	$9,760	172%
Healthsmart Ppo - All Other Plans	$10,010	176%
Meridian Mcaid - All Plans	$10,375	183%
Iowa Total Care Mcaid - All Plans	$10,582	186%
Medicaid / KanCare	$10,686	188%
Health Alliance-All Plans	$11,261	198%
Humana	$11,261	198%
Midlands Choice-All Plans	$11,511	203%
Mutually Preferred-All Plans	$11,887	209%

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 $10,010.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify MS-DRG Code matches exactly: 392.

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 MS-DRG code 392.
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.