CMS Price Transparency Data

Total knee replacement

Facility: Boone County Hospital

Billing Code: 27447 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 27447
Insurance Median: $2,215
Cash Discount Price: $2,640
vs. Medicare Baseline: 0.17x Medicare

The contracted insurance negotiated median rate for a Total knee replacement at Boone County Hospital is $2,215. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $2,640. Compared to the federal Medicare reimbursement reference rate of $13,116.76, this hospital’s rate is 0.17x the Medicare baseline. Located in 1015 Union Street, Boone, IA.

Cash / Self-Pay

$2,640

Average discount available for prompt cash payment at this facility.

Insurance Median

$2,215

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: $2,640 (20%)

Insurance Median: $2,215 (17%)

Cash: $2,640 (20% of Medicare)

Ins. Median: $2,215 (17% 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	$1,046	8%
Humana	$1,046 - $3,211	8%
Iowa Hlth Adv - All Plans	$1,046	8%
Mt Carmel Hp - All Plans	$1,046	8%
Va Ccn-All Plans	$1,046	8%
Amerigroup Mcr Adv - All Other Plans	$1,056	8%
Aetna	$1,066 - $2,475	8%
UnitedHealthcare	$1,196 - $1,920	9%
Healthsmart Accell Network	$1,202	9%
Tricare	$1,213 - $1,427	9%
Health Alliance-All Plans	$1,255	10%
Healthsmart Ppo - All Other Plans	$1,255	10%
Medical Associates Hp-All Plans	$1,986	15%
Wellmark Hmo	$2,443	19%
Midlands Choice-All Plans	$2,747	21%
Health Partners Profee Only - All Plans	$2,752	21%
Wellmark Ppo - All Other Plans	$2,868	22%
Mutually Preferred-All Plans	$2,881 - $3,390	22%
Meridian Mcaid - All Plans	$3,033 - $3,568	23%
Iowa Total Care Mcaid - All Plans	$3,094 - $3,639	24%
Medicaid / KanCare	$3,124 - $3,675	24%

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 $2,640.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 27447.

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 27447.
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.