CMS Price Transparency Data

Hip or knee replacement (inpatient stay)

Facility: Baptist Health Hardin

Billing Code: 470 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 470
Insurance Median: $25,686
Cash Discount Price: $119,676
vs. Medicare Baseline: 1.83x Medicare

The contracted insurance negotiated median rate for a Hip or knee replacement (inpatient stay) at Baptist Health Hardin is $25,686. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $119,676. Compared to the federal Medicare reimbursement reference rate of $14,044.15, this hospital’s rate is 1.83x the Medicare baseline. Located in 913 North Dixie Avenue, Elizabethtown, KY.

Cash / Self-Pay

$119,676

Average discount available for prompt cash payment at this facility.

Insurance Median

$25,686

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$14,044.15

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $14,044.15 (100%)

Cash / Self-Pay: $119,676 (852%)

Insurance Median: $25,686 (183%)

Cash: $119,676 (852% of Medicare)

Ins. Median: $25,686 (183% of 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.

Billing Status

Remaining Deductible ($)

Your Coinsurance Rate (%)

Input your details and click calculate to compare out-of-pocket costs.

Commercial Insurance Negotiated Rates

Negotiated contract ranges established by major commercial carriers at this facility.

Carrier / Plan Group	Contract Rate Range	vs. Medicare Reference
Wellcare Mcaid	$10,143 - $15,190	72%
Aetna	$10,959 - $56,458	78%
Blue Cross Blue Shield	$11,658 - $159,567	83%
Humana	$11,658 - $31,071	83%
Molina Mcaid - All Plans	$11,658 - $12,152	83%
UnitedHealthcare	$11,658 - $46,548	83%
Sig Advantage - All Plans	$12,975	92%
Wellcare Mcr Adv - All Other Plans	$12,975 - $13,818	92%
Wellmark Mcr Adv - All Plans	$12,975 - $13,818	92%
Signature Adv - All Plans	$13,818	98%
Cigna	$19,274 - $24,003	137%
Siho Exclus Ntwrk	$19,289	137%
Siho Dual Ntwrk	$23,147	165%
Caresource-All Plans	$23,356 - $27,467	166%
Healthlink-All Plans	$23,664 - $23,911	168%
Siho Ppo - All Other Plans	$27,005	192%
Siho-All Plans	$27,005	192%
Center Care - All Plans	$30,182	215%
Phcs-All Plans	$72,807 - $89,264	518%
Encore Preferred	$80,582	574%
Multiplan-All Plans	$104,184 - $126,058	742%
Center Care-All Plans	$109,553	780%
Encore Ppo - All Other Plans	$137,068	976%

Self-Pay Upfront Cash Action Plan

Request a "Self-Pay classification" with the billing desk before receiving care.
Ask for a written "Prompt-Pay Discount" agreement quoting the price of $119,676.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify MS-DRG Code matches exactly: 470.

Insurance In-Network Protection Plan

Contact your insurance company to confirm Baptist Health Hardin is fully in-network.
Ask your insurer if "Prior Authorization" is required for MS-DRG code 470.
Confirm the specific physician or imaging center is also in-network (not just the hospital building).
Audit your Explanation of Benefits (EOB) against the final itemized hospital invoice.