CMS Price Transparency Data

Hip or knee replacement (inpatient stay)

Facility: Winnmed

Billing Code: 470 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 470
Insurance Median: $31,631
Cash Discount Price: $24,172
vs. Medicare Baseline: 2.25x Medicare

The contracted insurance negotiated median rate for a Hip or knee replacement (inpatient stay) at Winnmed is $31,631. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $24,172. Compared to the federal Medicare reimbursement reference rate of $14,044.15, this hospital’s rate is 2.25x the Medicare baseline. Located in 901 Montgomery Street, Decorah, IA.

Cash / Self-Pay

$24,172

Average discount available for prompt cash payment at this facility.

Insurance Median

$31,631

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%)

Cash / Self-Pay: $24,172 (172%)

Insurance Median: $31,631 (225%)

Cash: $24,172 (172% of Medicare)

Ins. Median: $31,631 (225% 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.

Elevated Commercial Rate Alert (Value-Gap)

The negotiated rate at this facility is 225% of the Medicare baseline (a markup of 125%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.

Consult Patient Advocate

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
Blue Cross Blue Shield	$18,992 - $24,172	135%
UnitedHealthcare	$20,132	143%
Aetna	$31,078 - $33,496	221%
Health Partners - All Plans	$31,631	225%
Medica Mayo Clinic	$31,631	225%
Medica Ifb	$31,769	226%
Medica Mayo Health Plan - All Other Plans	$32,805	234%
Preferred One - All Plans	$32,805	234%

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 $24,172.
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 Winnmed 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.