Boone Memorial Hospital
701 Madison Avenue, Madison, WV 25130 · 108 Priced Procedures · 90% Patient Recommendation
Typical commercial prices here are 4% below the fair benchmark (0.96×) after accounting for local nurse/doctor wages and patient complexity.
5-Star CMS clinical quality rating paired with 0.96× fair market pricing.
Loss-Leader / Captive Ancillary Cross-Subsidizer
Boone Memorial Hospital prices routine shoppable procedures near 1.4× Medicare (p50 0.77×) while skewing captive emergency, lab, and upper-quartile codes to 1.6× Medicare (p75 1.43×, +86% upper-tail jump). Patients scheduling elective outpatient care can capture competitive rates, but emergency and ancillary bills require strict line-item auditing.
Where They're Good (Patient & Payer Edge)
- Elective shoppable care is priced 4% below peer Fair BaseRate (0.96×)
- Self-pay cash beats commercial insurance on 44% of shoppable procedures (99/100 Cash Honesty)
- 4-Star CMS clinical rating with 90% patient recommendation (83/100 safety score)
- IRS 501(c)(3) charity care provides free care up to 200% FPL and discounted care up to 400% FPL (28.8% AGB cap)
Where You Can Get Burned (Markup Traps)
- Even at low-cost facilities (0.96× Fair BaseRate), out-of-network or unnegotiated chargemaster bills can exceed commercial medians — confirm in-network status or request a self-pay cash quote up front.
- Captive ER (1.5×) & laboratory (1.6×) services average 1.14× higher multiples than routine shoppable care (1.4×)
- Upper-quartile procedures (Q75 1.43×) jump +86% above the median procedure ratio (Q50 0.77×)
- Consolidated metro market (HHI 6,304) limits in-network hospital competition (Highly Concentrated Monopoly (>2,500))
Pre-scheduled outpatient procedures where patients can comparison-shop.
Emergency, inpatient DRG, lab, and specialty drug lines billed after admission.
Detects median-gaming when upper-quartile codes spike above the p50 median.
Procedure Prices at Boone Memorial Hospital
High-impact clinical procedures (MRIs, surgeries, inpatient stays, visits) are prioritized first. Use the category pills or search bar to filter all 108 published procedures.
| Procedure & Billing Code | This Hospital | vs. Fair |
|---|---|---|
| Total knee replacement CPT Code: 27447 | $9,483 | 0.7× |
| Rabies immune globulin HCPCS Code: 90375 | $4,872 | unverified |
| Gallbladder removal (laparoscopic) CPT Code: 47562 | $4,218 | 0.7× |
| Inguinal hernia repair CPT Code: 49505 | $2,600 | 0.7× |
| Bunion correction surgery CPT Code: 28296 | $2,544 | 0.7× |
| Knee arthroscopy with meniscus repair CPT Code: 29881 | $2,454 | 0.7× |
| Breast lump removal CPT Code: 19120 | $1,593 | 0.4× |
| Hepatitis B immune globulin HCPCS Code: 90371 | $1,559 | unverified |
| MRI, brain (with and without contrast) CPT Code: 70553 | $991 | 1.9× |
| CT scan, abdomen and pelvis (with contrast) CPT Code: 74177 | $806 | 1.8× |
| Colonoscopy (diagnostic) CPT Code: 45378 | $709 | 0.7× |
| CT scan, abdomen and pelvis (no contrast) CPT Code: 74176 | $684 | unverified |
| MRI, brain (no contrast) CPT Code: 70551 | $637 | 1.9× |
| MRI, knee or other leg joint CPT Code: 73721 | $639 | 1.7× |
| Sleep study (overnight, in lab) CPT Code: 95810 | $645 | 0.6× |
| MRI, lower back (no contrast) CPT Code: 72148 | $657 | unverified |
| CT scan, head (with and without contrast) CPT Code: 70470 | $584 | 2.3× |
| Echocardiogram (heart ultrasound) CPT Code: 93306 | $598 | 1.0× |
| Colonoscopy with biopsy CPT Code: 45380 | $562 | 0.4× |
| CT scan, head (with contrast) CPT Code: 70460 | $501 | 2.1× |
| CT scan, pelvis CPT Code: 72192 | $453 | 2.8× |
| CT scan, chest (no contrast) CPT Code: 71250 | $420 | 2.5× |
| Upper endoscopy with biopsy CPT Code: 43239 | $434 | 0.4× |
| CT scan, neck (cervical spine) CPT Code: 72125 | $454 | unverified |
| CT scan, lower back (lumbar spine) CPT Code: 72131 | $451 | unverified |
Audit a Bill or Quote at Boone Memorial Hospital (Zero PHI Required)
Statutory 501(r) AGB Cap Limits Bill to $9,768
At 274% FPL (201%–400% FPL tier), 26 U.S.C. § 501(r)(5) caps FAP-eligible bills at Amounts Generally Billed (28.8% of gross = $9,768).
Self-Pay Cash Rate ($16,935) Beats Your Bill
Boone Memorial Hospital's published 45 CFR § 180 self-pay cash rate is $16,935 (vs. $9,483 commercial insurer median). Ask billing to reclassify the visit to prompt-pay self-pay if it beats your deductible.
Negotiate Toward $13,523 Fair BaseRate ($13,117 Medicare)
Your bill ($33,869) is $20,346 above the denoised Fair BaseRate ($13,523) and 2.6× the $13,117 Medicare rate.
Financial Assistance Policy (FAP) & Amounts Generally Billed (AGB)
Hospital-Specific CMS HCRIS Benchmark (28.8% of gross charges)
Under 26 U.S.C. § 501(r)(5), a tax-exempt hospital organization may not bill FAP-eligible patients more than Amounts Generally Billed (AGB) to individuals with insurance covering emergency or medically necessary care. Derived from this facility’s reported CMS HCRIS cost-to-charge & insurer allowance filings. Verify your exact Financial Assistance Policy (FAP) determination directly with the billing office.
Clinical Quality, Patient Experience & Infection Benchmarks
Source: CMS Hospital Care Compare (116 completed HCAHPS patient surveys). Clinical quality metrics summarize historical facility-wide cohorts and are not medical advice for individual care decisions.
How to Pay Less Nearby: Freestanding Centers, Insurer Leverage & Outpatient Savings
2D regional comparison of commercial negotiated price index against CMS clinical quality composite for Boone Memorial Hospital.
Verify the Raw Data: Official Hospital MRF, CMS Medicare.gov & Federal Filings
Safe-Harbor Data Corrections: Parsed directly from public 45 CFR § 180 hospital filings, CMS Care Compare, and CMS HCRIS cost reports. Hospital compliance officers may submit updated MRF URLs or rate tables for verification.