Hip or knee replacement (inpatient stay)
Facility: Nemaha Valley Community Hospital
Billing Code: 470 (MS-DRG)
- CPT Billing Code: 470
- Insurance Median: $16,626
- Cash Discount Price: $44,218
- vs. Medicare Baseline: 1.18x 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 |
|---|---|---|
| Va Ccn - All Plans | $9,156 | 65% |
| Humana | $9,156 | 65% |
| Aetna | $9,248 - $41,761 | 66% |
| Celtic Comm Exch - All Plans | $10,072 | 72% |
| Partners Direct Health - All Plans | $11,100 | 79% |
| Blue Cross Blue Shield | $22,152 | 158% |
| Multiplan - All Plans | $44,218 | 315% |
| Midlands Choice - All Plans | $46,674 | 332% |
| Health Partners - All Plans | $46,674 | 332% |
Consumer Guidance & Cost Commentary
For a hip or knee replacement at Nemaha Valley Community Hospital in Seneca, KS, the cash price of $44,218 is significantly lower than the facility's gross charge of $49,131. While the hospital's negotiated rates with major payers like Aetna and Blue Cross Blue Shield range from $9,156 to $44,218, the cash price remains the most transparent benchmark for patients. It is important to note that for individuals with high-deductible plans, paying the cash price upfront can sometimes result in lower out-of-pocket costs if the insurance company's negotiated rate exceeds the cash price, though this depends entirely on your specific plan's deductible status. Patients should always verify "self-pay" or "prompt-pay" discounts directly with the hospital before scheduling, as these upfront fee reductions can further lower the final amount owed.
This procedure carries a Medicare benchmark of $14,044, which serves as the objective baseline for evaluating pricing markups. The facility's cash rate is approximately 3.1 times the Medicare amount, reflecting the standard administrative and profit margins inherent in commercial billing. If you receive a bill that includes charges for out-of-network services, such as certain lab tests or emergency physician services, you may be subject to balance billing, where you are responsible for the difference between the provider's full charge and your insurance's allowed amount. However, the No Surprises Act protects patients from these surprise bills for emergency care and non-emergency services at in-network facilities. To ensure accuracy, request a full itemized bill to review every code and unit cost, as over 80% of hospital bills contain errors that can be corrected through a