Hip or knee replacement (inpatient stay)
Facility: Sarah Bush Lincoln Health Center
Billing Code: 470 (MS-DRG)
- CPT Billing Code: 470
- Insurance Median: $42,317
- Cash Discount Price: $53,566
- vs. Medicare Baseline: 3.01x Medicare
Average discount available for prompt cash payment at this facility.
Median negotiated contract rate across all mapped commercial carriers.
Standard federal government reimbursement rate for this code.
Visual Cost Comparison vs. 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 301% of the Medicare baseline (a markup of 201%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.
Out-of-Pocket Cost Estimator
Estimate whether it is more economical to use your insurance or pay the upfront self-pay cash rate.
Commercial Insurance Negotiated Rates
Negotiated contract ranges established by major commercial carriers at this facility.
| Carrier / Plan Group | Contract Rate Range | vs. Medicare Reference |
|---|---|---|
| Aetna | $15,067 - $49,281 | 107% |
| Bc Comm Mmai | $15,067 | 107% |
| Beacon Health Options Behav-All Plans | $15,067 | 107% |
| Hlth Alliance Mcr Adv | $15,067 | 107% |
| Humana | $15,067 - $15,368 | 107% |
| Meridian Mmai-All Other Plans | $15,067 | 107% |
| Molina Mmai-All Other Plans | $15,067 | 107% |
| Tricare | $15,067 | 107% |
| UnitedHealthcare | $15,067 - $44,460 | 107% |
| Va Ccn-All Plans | $15,067 | 107% |
| Wellcare Med Adv-All Plans | $15,067 | 107% |
| Bc Med Adv Ppo/Hmo | $15,519 | 111% |
| Plain Church Mg-All Plans | $21,426 | 153% |
| Mennonite-All Plans | $24,105 | 172% |
| Eiu Athlete-All Other Plans | $37,496 | 267% |
| Healthscope-All Plans | $39,639 | 282% |
| Rural King-All Plans | $39,639 | 282% |
| Blue Cross Blue Shield | $42,317 - $42,853 | 301% |
| Consociate-All Plans | $42,853 | 305% |
| Hope Trust-All Plans | $42,853 | 305% |
| Eiu Student | $43,924 | 313% |
| Allied National-All Plans | $44,996 | 320% |
| Companion Life-All Plans | $44,996 | 320% |
| Hlth Alliance-All Other Plans | $44,996 | 320% |
| First Health-All Plans | $45,531 | 324% |
| Innovative Hlthware-All Plans | $45,531 | 324% |
| Healthlink Hmo | $46,067 | 328% |
| Healthlink Ppo - All Other Plans | $46,067 | 328% |
| Multiplan-All Plans | $46,067 | 328% |
| Cigna | $48,210 | 343% |
| Cphp-All Plans | $48,210 | 343% |
| Beech Street-All Plans | $49,281 | 351% |
| Hfn-All Plans | $49,281 | 351% |