Hip or knee replacement (inpatient stay)
Facility: William Newton Hospital
Billing Code: 470 (MS-DRG)
- CPT Billing Code: 470
- Insurance Median: $14,294
- Cash Discount Price: $36,335
- vs. Medicare Baseline: 1.02x 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 |
|---|---|---|
| Triwest- All Plans | $7,103 | 51% |
| Blue Cross Blue Shield | $7,323 - $18,167 | 52% |
| Ambetter / Centene | $7,323 - $10,421 | 52% |
| UnitedHealthcare | $7,323 - $35,884 | 52% |
| Providrs Care Nexus | $18,978 | 135% |
| Providrs Care - All Other Plans | $26,785 | 191% |
Consumer Guidance & Cost Commentary
For a hip or knee replacement at William Newton Hospital in Winfield, KS, the cash price is $36,335, which matches the facility's median negotiated rate. While commercial payers like UnitedHealthcare and Blue Cross Blue Shield have negotiated rates ranging from $7,323 to $35,884 depending on the specific plan, the cash price remains the lowest fixed amount available for patients without insurance. It is important to note that for individuals with high-deductible plans, paying the cash price upfront can sometimes be more affordable than the insurance negotiated rate, as the patient would otherwise face the higher allowed amount before their deductible is met. Since this is a Critical Access Hospital, patients should explicitly ask about "self-pay" or "prompt-pay" discounts before scheduling, as these upfront fee reductions can significantly lower the final bill compared to standard billing cycles.
This procedure is categorized under MS-DRG code 470, and the facility's pricing is benchmarked against the national Medicare rate of $14,044.15. The cash price of $36,335 represents a 100% markup over the Medicare amount, which is a common pricing structure for commercial services that includes administrative overhead and profit margins. Because over 80% of hospital bills contain errors, patients should request a detailed, itemized statement rather than accepting a summary bill, as this allows them to identify unbundled codes or services not rendered. If a patient receives a balance bill from an out-of-network provider at this in-network facility, they may be entitled to protections under the No Surprises Act, which bans balance billing for emergency and non-emergency services, so any