CMS Price Transparency Data

Hip or knee replacement (inpatient stay)

Facility: Dukes Memorial Hospital

Billing Code: 470 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 470
Insurance Median: $4,414
Cash Discount Price: Unavailable
vs. Medicare Baseline: 0.31x Medicare

The contracted insurance negotiated median rate for a Hip or knee replacement (inpatient stay) at Dukes Memorial Hospital is $4,414. 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 0.31x the Medicare baseline. Located in 275 W 12Th St, Peru, IN.

Cash / Self-Pay

Unavailable

Average discount available for prompt cash payment at this facility.

Insurance Median

$4,414

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: $4,414 (31%)

Ins. Median: $4,414 (31% 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	$3,531 - $27,601	25%
Encore Work Comp In	$3,973	28%
Prime Health Services	$3,973	28%
Humana	$4,360	31%
Iu Health Plan	$4,360	31%
Managed Health Services	$4,360 - $8,828	31%
Medicare (plans)	$4,360	31%
Node Devoted Health Mcr Adv	$4,360	31%
UnitedHealthcare	$4,360 - $4,414	31%
Lutheran Advanced Network	$4,414	31%
Lutheran Northwest Health Preferred	$4,414	31%
Lutheran Three Rivers Preferred Plus 150	$4,414	31%
Lutheran Three Rivers Preferred Plus 175	$4,414	31%
Miami County Sheriffs Department	$4,414	31%
Node Lutheran Preferred Fixed 2	$4,414	31%
Work Comp	$4,414	31%
Aetna	$4,447	32%
In Dept Of Correction	$4,591	33%
Node Pphp Mcr Adv	$4,635	33%
Partners Direct Health Llc	$5,600	40%
Encore Kba Epo	$10,594	75%
Three Rivers Preferred Plus	$11,139	79%
Encore Kba Ppo	$13,242	94%
Three Rivers Preferred	$14,177	101%
Lutheran Preferred	$14,366	102%
Amish Aid	$15,181	108%
Encore Ppo	$25,317	180%

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 Dukes 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.