CMS Price Transparency Data

Hip or knee replacement (inpatient stay)

Facility: Hammond Henry Hospital

Billing Code: 470 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 470
Insurance Median: $22,717
Cash Discount Price: $49,144
vs. Medicare Baseline: 1.62x Medicare

The contracted insurance negotiated median rate for a Hip or knee replacement (inpatient stay) at Hammond Henry Hospital is $22,717. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $49,144. Compared to the federal Medicare reimbursement reference rate of $14,044.15, this hospital’s rate is 1.62x the Medicare baseline. Located in 600 N College Avenue, Geneseo, IL.

Cash / Self-Pay

$49,144

Average discount available for prompt cash payment at this facility.

Insurance Median

$22,717

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: $49,144 (350%)

Insurance Median: $22,717 (162%)

Cash: $49,144 (350% of Medicare)

Ins. Median: $22,717 (162% 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
Humana	$1,800 - $9,439	13%
Multiplan Phcs Pediatric	$1,800	13%
Cigna	$3,465	25%
Healthsmart Adult-All Other Plans	$3,600	26%
Healthsmart Pediatric	$3,600	26%
Usa Mco-All Plans	$3,750	27%
Multiplan Phcs Adult	$3,825	27%
Tricare	$8,495	60%
Aetna	$9,439 - $40,953	67%
Health Alliance Mcare Adv	$9,439	67%
UnitedHealthcare	$9,439 - $26,420	67%
Springfield Armory-All Plans	$13,200	94%
Ambetter / Centene	$14,736	105%
Blue Cross Blue Shield	$22,717 - $23,127	162%
Quad City Community Hc-All Plans	$25,420	181%
Wellmark Of Ia-All Plans	$27,302	194%
Health Alliance-All Other Plans	$40,953	292%
Multiplan Integrated Hp	$40,953	292%
Multiplan Pponext	$43,683	311%
Osf Direct Access Network-All Plans	$43,683	311%
Multiplan-All Other Plans	$46,414	330%
Corvel-All Plans	$49,144	350%
Hfn-All Plans	$49,144	350%
Multiplan Beech Street	$49,144	350%

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 $49,144.
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 Hammond Henry 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.