Hip or knee replacement (inpatient stay)
Facility: Hiawatha Community Hospital
Billing Code: 470 (MS-DRG)
- CPT Billing Code: 470
- Insurance Median: $23,270
- Cash Discount Price: $32,516
- vs. Medicare Baseline: 1.66x 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 |
|---|---|---|
| Humana | $7,248 | 52% |
| Aetna | $7,248 - $27,249 | 52% |
| UnitedHealthcare | $7,248 - $27,931 | 52% |
| Wppa Providrs Care - All Plans | $7,330 | 52% |
| Ambetter / Centene | $8,698 | 62% |
| Healthy Blue Mcaid - All Plans | $10,421 | 74% |
| Blue Cross Blue Shield | $21,044 - $22,152 | 150% |
| Oscar - All Plans | $24,387 | 174% |
| Centrus Health Direct - All Plans | $26,013 | 185% |
| Preferred Hlth - All Plans | $29,265 | 208% |
| Cigna | $30,890 | 220% |
| Midlands Choice - All Plans | $31,541 | 225% |
| Multiplan - All Plans | $31,541 | 225% |
Consumer Guidance & Cost Commentary
For a hip or knee replacement at Hiawatha Community Hospital in Hiawatha, KS, the cash price is $32,516, which matches the facility's median negotiated rate. This cash price is significantly higher than the state average for this procedure, indicating that patients paying out-of-pocket may face elevated costs compared to regional norms. While commercial insurance plans like Aetna and UnitedHealthcare negotiate rates ranging from $7,248 to $27,931, these figures often exceed the cash price, meaning self-pay patients might save money by paying directly, provided they qualify for the cash rate. It is important to verify if your specific plan has a deductible that would require you to pay the full negotiated amount before insurance coverage begins.
The facility's billing practices align with standard industry benchmarks, where commercial negotiated rates typically range from 200% to 300% of the Medicare rate of $14,044.15, though this specific code shows a lower ratio of 1.7x. To minimize potential debt, patients should request an itemized bill to review every charge, ensuring no unbundled services or non-rendered items are included, as over 80% of hospital bills contain errors. Additionally, asking about prompt-pay discounts before scheduling can reduce the final cost by 20% to 50% for upfront payments, bypassing the administrative overhead associated with insurance claims processing.