CMS Price Transparency Data

Hip or knee replacement (inpatient stay)

Facility: Great Plains Health

Billing Code: 470 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 470
Insurance Median: $54,692
Cash Discount Price: $35,476
vs. Medicare Baseline: 3.89x Medicare

The contracted insurance negotiated median rate for a Hip or knee replacement (inpatient stay) at Great Plains Health is $54,692. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $35,476. Compared to the federal Medicare reimbursement reference rate of $14,044.15, this hospital’s rate is 3.89x the Medicare baseline. Located in 601 West Leota St, North Platte, NE.

Cash / Self-Pay

$35,476

Average discount available for prompt cash payment at this facility.

Insurance Median

$54,692

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: $35,476 (253%)

Insurance Median: $54,692 (389%)

Cash: $35,476 (253% of Medicare)

Ins. Median: $54,692 (389% 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.

Elevated Commercial Rate Alert (Value-Gap)

The negotiated rate at this facility is 389% of the Medicare baseline (a markup of 289%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.

Consult Patient Advocate

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
Nebraska Total Care	$7,339	52%
Molina	$8,006	57%
Ambetter / Centene	$33,359	238%
Midwest Network Alliance	$50,062 - $51,540	356%
Blue Cross Blue Shield	$52,622	375%
Medica	$54,396	387%
Midlands Choice	$54,987	392%
Oscar Health	$54,987	392%
Coventry	$55,578 - $56,170	396%
Geha	$55,578	396%
Mutual Of Omaha	$56,170	400%
UnitedHealthcare	$56,170	400%

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 $35,476.
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 Great Plains Health 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.