CMS Price Transparency Data

Hip or knee replacement (inpatient stay)

Facility: Woodlawn Hospital

Billing Code: 470 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 470
Insurance Median: $15,977
Cash Discount Price: $41,796
vs. Medicare Baseline: 1.14x Medicare

The contracted insurance negotiated median rate for a Hip or knee replacement (inpatient stay) at Woodlawn Hospital is $15,977. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $41,796. Compared to the federal Medicare reimbursement reference rate of $14,044.15, this hospital’s rate is 1.14x the Medicare baseline. Located in 1400 E 9Th St, Rochester, IN.

Cash / Self-Pay

$41,796

Average discount available for prompt cash payment at this facility.

Insurance Median

$15,977

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: $41,796 (298%)

Insurance Median: $15,977 (114%)

Cash: $41,796 (298% of Medicare)

Ins. Median: $15,977 (114% 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
Aetna	$5,356 - $52,942	38%
Caresource Mcaid Hip	$5,356	38%
Caresource Mcr Adv	$5,356	38%
Humana	$5,356 - $44,176	38%
Mdwise Mcaid Excel Hip	$5,356	38%
Mhs Exch Mrktplce-All Other Plans	$5,356	38%
Mhs Mcaid Hip	$5,356	38%
UnitedHealthcare	$5,356 - $42,353	38%
Mhs Mcr Adv	$5,463	39%
Blue Cross Blue Shield	$5,517 - $42,353	39%
Caresource Exch - All Other Plans	$6,963	50%
Ambetter / Centene	$7,123	51%
Caresource Mcaid Hww	$15,977	114%
Mdwise Excel Hhw & Hcc	$15,977	114%
Mhs Mcaid Hcc	$15,977	114%
Mhs Mcaid Hhw	$15,977	114%
Partners Direct Health-All Plans	$25,076	179%
Cigna	$39,901 - $47,369	284%
Parkview Health Plans-All Plans	$41,796	298%
Sagamore All Other Grps - All Other Plans	$46,812	333%
Encore Comm-All Plans	$47,369	337%
Phcs/Multiplan-All Plans	$51,827	369%
Community Health Alliance-All Plans	$52,942	377%

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 $41,796.
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 Woodlawn 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.