CMS Price Transparency Data

Hip or knee replacement (inpatient stay)

Facility: Butler County Health

Billing Code: 470 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 470
Insurance Median: $51,780
Cash Discount Price: $53,962
vs. Medicare Baseline: 3.69x Medicare

The contracted insurance negotiated median rate for a Hip or knee replacement (inpatient stay) at Butler County Health is $51,780. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $53,962. Compared to the federal Medicare reimbursement reference rate of $14,044.15, this hospital’s rate is 3.69x the Medicare baseline. Located in 372 South 9Th Street, David City, NE.

Cash / Self-Pay

$53,962

Average discount available for prompt cash payment at this facility.

Insurance Median

$51,780

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: $53,962 (384%)

Insurance Median: $51,780 (369%)

Cash: $53,962 (384% of Medicare)

Ins. Median: $51,780 (369% 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 369% of the Medicare baseline (a markup of 269%). 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
Humana	$5,597	40%
Ambetter / Centene	$50,765 - $51,763	361%
Blue Cross Blue Shield	$50,765 - $51,763	361%
Multiplan	$50,765 - $51,763	361%
Nebraska Total Care	$50,765 - $51,763	361%
Aetna	$51,780 - $52,798	369%
Cigna	$52,368 - $53,397	373%
Medica	$52,368 - $53,397	373%
Midlands Choice	$52,368 - $53,397	373%
Three Rivers	$52,368 - $53,397	373%
UnitedHealthcare	$52,368 - $53,397	373%

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 $53,962.
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 Butler County 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.