CMS Price Transparency Data

Total hip replacement

Facility: Boone County Hospital

Billing Code: 27130 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 27130
Insurance Median: $1,656
Cash Discount Price: $2,644
vs. Medicare Baseline: 0.13x Medicare

The contracted insurance negotiated median rate for a Total hip replacement at Boone County Hospital is $1,656. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $2,644. Compared to the federal Medicare reimbursement reference rate of $13,116.76, this hospital’s rate is 0.13x the Medicare baseline. Located in 1015 Union Street, Boone, IA.

Cash / Self-Pay

$2,644

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,656

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$13,116.76

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $13,116.76 (100%)

Cash / Self-Pay: $2,644 (20%)

Insurance Median: $1,656 (13%)

Cash: $2,644 (20% of Medicare)

Ins. Median: $1,656 (13% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $13,116.76 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
Choice Care Mcr Adv - All Plans	$1,047 - $1,465	8%
Humana	$1,047 - $3,216	8%
Iowa Hlth Adv - All Plans	$1,047 - $1,465	8%
Mt Carmel Hp - All Plans	$1,047 - $1,465	8%
Va Ccn-All Plans	$1,047 - $1,465	8%
Amerigroup Mcr Adv - All Other Plans	$1,058 - $1,480	8%
Aetna	$1,068 - $2,787	8%
UnitedHealthcare	$1,197 - $2,098	9%
Healthsmart Accell Network	$1,205 - $2,501	9%
Tricare	$1,215 - $13,117	9%
Health Alliance-All Plans	$1,257 - $3,216	10%
Healthsmart Ppo - All Other Plans	$1,257 - $2,859	10%
Meridian Mcaid - All Plans	$1,367 - $3,573	10%
Iowa Total Care Mcaid - All Plans	$1,394 - $3,645	11%
Medicaid / KanCare	$1,408 - $3,680	11%
Medical Associates Hp-All Plans	$1,990 - $2,680	15%
Wellmark Hmo	$2,446 - $19,010	19%
Health Partners Profee Only - All Plans	$2,705	21%
Midlands Choice-All Plans	$2,751 - $3,287	21%
Wellmark Ppo - All Other Plans	$2,871 - $20,873	22%
Mutually Preferred-All Plans	$2,885 - $3,395	22%

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 $2,644.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 27130.

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 27130.
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.