Hip or knee replacement (inpatient stay)
Facility: Nmc Health
Billing Code: 470 (MS-DRG)
- CPT Billing Code: 470
- Insurance Median: $22,758
- Cash Discount Price: $27,258
- vs. Medicare Baseline: 1.62x Medicare
Average discount available for prompt cash payment at this facility.
Median negotiated contract rate across all mapped commercial carriers.
Standard federal government reimbursement rate for this code.
Visual Cost Comparison vs. 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.
Commercial Insurance Negotiated Rates
Negotiated contract ranges established by major commercial carriers at this facility.
| Carrier / Plan Group | Contract Rate Range | vs. Medicare Reference |
|---|---|---|
| Bluestem Pace | $5,597 | 40% |
| Leading Age | $9,427 | 67% |
| Medicaid / KanCare | $9,427 | 67% |
| Aetna | $20,112 | 143% |
| Wppa | $21,417 | 152% |
| Blue Cross Blue Shield | $22,152 | 158% |
| Occunet | $23,364 | 166% |
| Medincrease Health Plan | $25,311 | 180% |
| Samaritan Ministries International | $25,311 | 180% |
| Prime Health Services | $29,205 | 208% |
| UnitedHealthcare | $33,099 | 236% |
| Cigna | $36,993 | 263% |
Consumer Guidance & Cost Commentary
For a hip or knee replacement at Nmc Health in Newton, Kansas, the cash price of $27,258 is significantly lower than the facility's gross charge of $38,940. While the facility offers a negotiated rate of $22,758 to in-network insurers like Bluestem Pace and Leading Age, patients with high-deductible plans may find paying the cash price directly more cost-effective, as the cash rate is already below the negotiated amount. It is important to note that commercial rates often include administrative overhead and contract markups that can exceed the true cost of care, which is reflected in the Medicare benchmark of $14,044.15. To ensure you are not overpaying, always verify your specific plan's allowed amount before scheduling, as some insurers may negotiate higher rates than others, and consider asking the hospital about self-pay or prompt-pay discounts that could further reduce the final bill.
If you choose to use insurance, be aware that the negotiated rates vary widely among payers, ranging from $5,597 for Bluestem Pace to $36,993 for Cigna, with a median negotiated rate of $22,758. However, if your insurance plan has not yet met your deductible, you could be responsible for the full negotiated amount before any insurance payment is applied. To avoid unexpected costs, request an itemized bill before paying, as summary bills often hide unbundled charges or services not rendered. If you receive a balance bill from an out-of-network provider, even at an in-network facility, you have the right to dispute the charge under the No Surprises Act, and you should never sign