Hip or knee replacement (inpatient stay)
Facility: Wooster Community Hospital
Billing Code: 470 (MS-DRG)
- CPT Billing Code: 470
- Insurance Median: $28,469
- Cash Discount Price: $35,586
- vs. Medicare Baseline: 2.03x 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 203% of the Medicare baseline (a markup of 103%). 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 |
|---|---|---|
| The Health Plan Mcr Adv | $8,350 | 59% |
| Tricare | $12,012 | 86% |
| Aetna | $13,496 - $31,671 | 96% |
| Aultcare/Primecare Mcr Adv | $13,496 | 96% |
| Blue Cross Blue Shield | $13,496 - $32,739 | 96% |
| Buckeye Mcare | $13,496 | 96% |
| Caresource Mcr Adv | $13,496 | 96% |
| Humana | $13,496 - $33,451 | 96% |
| Med Mutual Of Oh Mcr | $13,496 | 96% |
| Molina Mcr | $13,496 | 96% |
| Summacare Mcr | $13,496 | 96% |
| UnitedHealthcare | $13,496 - $33,807 | 96% |
| Valor Hp Mcr-All Plans | $13,496 | 96% |
| Med Mutual Of Oh Exchange | $15,685 | 112% |
| Med Mutual Of Oh Trad-All Other Plans | $17,392 | 124% |
| Magnipower-All Plans | $17,545 | 125% |
| Buckeye Mcaid-All Other Plans | $18,149 | 129% |
| Caresource Mcaid | $18,149 | 129% |
| Molina Mcaid | $18,512 | 132% |
| Amerihealth Mcaid-All Plans | $19,056 | 136% |
| Caresource Exch - All Other Plans | $19,300 | 137% |
| Molina Marketplace - All Other Plans | $22,944 | 163% |
| Cerco-All Plans | $24,910 | 177% |
| Rayco-All Plans | $26,689 | 190% |
| Christian Health Ministries-All Plans | $28,469 | 203% |
| Cigna | $28,469 | 203% |
| Health Ohio Network Employer | $28,469 | 203% |
| Wayne County-All Plans | $28,469 | 203% |
| Med Mutual Of Oh Supermed | $28,897 | 206% |
| Healthsmart Accel | $29,536 | 210% |
| Healthsmart Complete Ppo-All Other Plans | $29,536 | 210% |
| Summacare Preferred Choice | $29,536 | 210% |
| Aultcare/Primetime Exch | $30,248 | 215% |
| Health Ohio Network Ppo-All Other Plans | $30,248 | 215% |
| Ohio Health Choice Supp | $30,248 | 215% |
| Ohio Health Group Hlthy - All Other Plans | $30,248 | 215% |
| Aultcare Wayne County | $30,700 | 219% |
| Ohio Health Group Pref | $31,671 | 226% |
| Aultcare/Primetime-All Other Plans | $32,027 | 228% |
| Health Plan Of Upper Ohio-All Plans | $32,278 | 230% |
| The Health Plan Comm - All Other Plans | $32,318 | 230% |
| Healthsmart Ppo | $32,383 | 231% |
| Summacare-All Other Plans | $33,095 | 236% |
| Ohio Health Choice-All Other Plans | $33,451 | 238% |
| Healthsmart Hpo | $33,807 | 241% |
| Osu-All Plans | $33,807 | 241% |
| Central Benefits-All Plans | $34,162 | 243% |
| First Health-All Plans | $34,162 | 243% |
| Flora-All Plans | $34,162 | 243% |
| Beech Street-All Plans | $34,518 | 246% |
| Phcs-All Plans | $34,518 | 246% |