CMS Price Transparency Data

Hip or knee replacement (inpatient stay)

Facility: Northwest Health - Porter

Billing Code: 470 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 470
Insurance Median: $16,766
Cash Discount Price: Unavailable
vs. Medicare Baseline: 1.19x Medicare

The contracted insurance negotiated median rate for a Hip or knee replacement (inpatient stay) at Northwest Health - Porter is $16,766. 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 1.19x the Medicare baseline. Located in 85 East Us Hwy 6, Valparaiso, IN.

Cash / Self-Pay

Unavailable

Average discount available for prompt cash payment at this facility.

Insurance Median

$16,766

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: $16,766 (119%)

Ins. Median: $16,766 (119% 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	$13,298 - $22,798	95%
Lutheran Preferred	$14,366 - $30,075	102%
Humana	$14,684	105%
Aetna	$14,772	105%
Blue Cross Blue Shield	$14,772 - $27,601	105%
Medicare (plans)	$14,772 - $16,143	105%
Node Mhs Mcr Adv	$14,772	105%
Healthy Indiana Plan	$15,038	107%
Care Improvement Plus	$15,510	110%
In Dept Of Correction	$15,639	111%
Node Devoted Health Mcr Adv	$16,465	117%
Node Va	$16,766	119%
Node Us Dept Of Labor	$23,592	168%
First Health Coventry	$25,110	179%
Encore Health	$27,068	193%
Preferred Network Access	$27,068	193%
Prime Health	$27,068	193%
Encore Ppo	$27,601	197%
Indiana Work Comp	$30,075	214%
Managed Health Services	$32,874	234%
Porter County	$36,090	257%
Node Encore Kba Epo	$39,449	281%
Magnacare Ma	$41,864	298%

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 Northwest Health - Porter 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.