Hip or knee replacement (inpatient stay)
Facility: Oakleaf Surgical Hospital
Billing Code: 470 (MS-DRG)
- CPT Billing Code: 470
- Insurance Median: $13,660
- Cash Discount Price: Unavailable
- vs. Medicare Baseline: 0.97x 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.
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 | $13,660 | 97% |
| Dean Health Plan | $13,660 | 97% |
| Group Health Cooperative Of Eau Claire | $13,660 | 97% |
| Healthpartners | $13,660 | 97% |
| Humana | $13,660 | 97% |
| Medica | $13,660 | 97% |
| Quartz Health Solutions | $13,660 | 97% |
| Security Health Plan Of Wi | $13,660 - $26,960 | 97% |
| Ucare Wi | $13,660 | 97% |
| UnitedHealthcare | $13,660 | 97% |
Consumer Guidance & Cost Commentary
For this procedure, the most meaningful benchmark available is the Medicare amount of $14,044.15, which serves as the federally validated baseline for the true cost of care. The negotiated rate of $13,660 represents the maximum amount in-network insurers are contractually allowed to pay, which is notably lower than the Medicare benchmark. While commercial insurance contracts often inflate prices due to administrative overhead, the data shows a rate that is approximately 2% lower than the Medicare standard, suggesting a favorable pricing structure compared to the federal cost basis.
Patients should be aware that cash-pay options may offer additional savings, as the data indicates a null value for the cash median, implying that specific cash rates were not reported for this facility. However, it is standard practice for hospitals to offer prompt-pay discounts of 20% to 50% to patients who settle bills upfront, which can bypass the multi-layered administrative costs embedded in commercial negotiated rates. To ensure you receive the best possible price, always request a self-pay or prompt-pay classification before check-in and demand a full itemized billing audit to confirm no errors or unbundled codes are inflating the final charge.