CMS Price Transparency Data

Hip or knee replacement (inpatient stay)

Facility: Wilcox Memorial Hospital

Billing Code: 470 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 470
Insurance Median: $21,453
Cash Discount Price: Unavailable
vs. Medicare Baseline: 1.53x Medicare

The contracted insurance negotiated median rate for a Hip or knee replacement (inpatient stay) at Wilcox Memorial Hospital is $21,453. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is unavailable. Compared to the federal Medicare reimbursement reference rate of $14,044.15, this hospital’s rate is 1.53x the Medicare baseline. Located in 3-3420 Kuhio Highway, Lihue, HI.

Cash / Self-Pay

Unavailable

Average discount available for prompt cash payment at this facility.

Insurance Median

$21,453

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$14,044.15

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $14,044.15 (100%)

Insurance Median: $21,453 (153%)

Ins. Median: $21,453 (153% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $14,044.15 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
UnitedHealthcare	$1,641	12%
Hcha	$8,162	58%
Verdegard	$8,797	63%
Pac Admin	$10,797	77%
Mdx	$11,362 - $23,950	81%
Uha	$11,682	83%
Hwmg/Hmaa	$13,175	94%
Hmsa	$22,948 - $23,950	163%
Alohacare	$23,950	171%
Ohana	$24,429	174%
Devoted	$25,147	179%
Kaiser	$45,822	326%

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 $X.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify MS-DRG Code matches exactly: 470.

Insurance In-Network Protection Plan

Contact your insurance company to confirm Wilcox Memorial Hospital is fully in-network.
Ask your insurer if "Prior Authorization" is required for MS-DRG code 470.
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.