CMS Price Transparency Data

Hip or knee replacement (inpatient stay)

Facility: Witham Health Services

Billing Code: 470 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 470
Insurance Median: $28,052
Cash Discount Price: $55,260
vs. Medicare Baseline: 2.00x Medicare

The contracted insurance negotiated median rate for a Hip or knee replacement (inpatient stay) at Witham Health Services is $28,052. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $55,260. Compared to the federal Medicare reimbursement reference rate of $14,044.15, this hospital’s rate is 2.00x the Medicare baseline. Located in 2605 N Lebanon St, Lebanon, IN.

Cash / Self-Pay

$55,260

Average discount available for prompt cash payment at this facility.

Insurance Median

$28,052

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: $55,260 (393%)

Insurance Median: $28,052 (200%)

Cash: $55,260 (393% of Medicare)

Ins. Median: $28,052 (200% 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
Blue Cross Blue Shield	$14,764 - $31,455	105%
Mdwise Health In-All Plans	$14,764	105%
Caresource Mcr Adv	$15,060	107%
Aetna	$15,207 - $58,417	108%
UnitedHealthcare	$22,738	162%
Caresource Indiana Marketplace-All Other Plans	$28,052	200%
Mhs Comml Exch-All Plans	$29,529	210%
Phcs/Multiplan-All Plans	$71,838	512%
Sagamore-All Plans	$72,627	517%
Humana	$73,417	523%
Beech Street-All Plans	$74,206	528%
Encore-All Plans	$74,995	534%

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 $55,260.
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 Witham Health Services 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.