Hip or knee replacement (inpatient stay)
Facility: Bob Wilson Memorial Hospital
Billing Code: 470 (MS-DRG)
- CPT Billing Code: 470
- Insurance Median: $28,883
- Cash Discount Price: Unavailable
- vs. Medicare Baseline: 2.06x 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.
Elevated Commercial Rate Alert (Value-Gap)
The negotiated rate at this facility is 206% of the Medicare baseline (a markup of 106%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.
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 |
|---|---|---|
| Blue Cross Blue Shield | $28,883 | 206% |
Consumer Guidance & Cost Commentary
For a hip or knee replacement at Bob Wilson Memorial Hospital in Ulysses, Kansas, the negotiated rate is $28,883, which is significantly higher than the Medicare benchmark of $14,044.15. This facility, a Critical Access Hospital owned by a voluntary non-profit church, has only one payer plan, Blue Cross Blue Shield, with a narrow range of $28,883. While commercial rates often average 200% to 300% of Medicare, this specific negotiated rate represents a substantial markup compared to the federal baseline. Because cash-pay rates are not available for this service, patients relying on insurance will pay the negotiated amount unless their plan covers a portion of the cost after meeting their deductible.
Patients should verify their out-of-pocket responsibility before scheduling, as the high negotiated rate may exceed what is covered under their specific plan. If you have a high-deductible plan, it is worth asking the hospital about "self-pay" or "prompt-pay" discounts, which can reduce the bill by 20% to 50% if paid upfront. Additionally, since over 80% of hospital bills contain errors, request a full itemized statement to review every charge for potential mistakes or unbundled codes. Always confirm that the facility is in-network and check your deductible status to avoid unexpected costs, as the No Surprises Act protects you from balance billing for emergency care but does not apply to elective procedures like joint replacements.