CMS Price Transparency Data

Hip or knee replacement (inpatient stay)

Facility: Henry County Memorial Hospital

Billing Code: 470 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 470
Insurance Median: $29,154
Cash Discount Price: $42,989
vs. Medicare Baseline: 2.08x Medicare

The contracted insurance negotiated median rate for a Hip or knee replacement (inpatient stay) at Henry County Memorial Hospital is $29,154. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $42,989. Compared to the federal Medicare reimbursement reference rate of $14,044.15, this hospital’s rate is 2.08x the Medicare baseline. Located in 1000 N 16Th St, New Castle, IN.

Cash / Self-Pay

$42,989

Average discount available for prompt cash payment at this facility.

Insurance Median

$29,154

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: $42,989 (306%)

Insurance Median: $29,154 (208%)

Cash: $42,989 (306% of Medicare)

Ins. Median: $29,154 (208% 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 208% of the Medicare baseline (a markup of 108%). 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	$15,118 - $32,868	108%
Caresource Hip	$15,118	108%
Humana	$15,118 - $54,044	108%
Caresource Mcr Adv	$15,420	110%
Caresource Mcaid	$18,135	129%
Caresource Marketplace-All Other Plans	$28,724	205%
Caresource Just4Me	$30,235	215%
Cigna	$41,761	297%
UnitedHealthcare	$49,990	356%
Aetna	$52,201	372%
Health Alliance-All Plans	$52,201	372%
Workers Comp - All Plans	$52,201	372%
Encore Workers Comp-All Plans	$58,343	415%

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 $42,989.
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 Henry County 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.