Hip or knee replacement (inpatient stay)
Facility: Susan B Allen Memorial Hospital
Billing Code: 470 (MS-DRG)
- CPT Billing Code: 470
- Insurance Median: $757
- Cash Discount Price: Unavailable
- vs. Medicare Baseline: 0.05x 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 |
|---|---|---|
| Aetna | $20,090 | 143% |
Consumer Guidance & Cost Commentary
For the hip or knee replacement procedure at Susan B Allen Memorial Hospital in El Dorado, KS, the facility's negotiated rate is significantly lower than the state average, offering a clear financial advantage for insured patients. While the Medicare benchmark for this service stands at $14,044.15, the hospital's negotiated rate is only $757.00, reflecting a substantial markup reduction compared to commercial averages that often range between 200% and 300% of the Medicare baseline. This pricing structure aligns with fair pricing standards, which typically fall between 120% and 150% of the Medicare rate, demonstrating that the facility is adhering to transparent, cost-effective contracting practices rather than inflating charges to maximize profit margins.
Patients should be aware that while cash payments can sometimes result in lower out-of-pocket costs for those with high-deductible plans, the hospital's specific negotiated rate already represents a highly competitive, pre-discounted price that may exceed the cash price. To ensure you receive the most favorable terms, it is essential to verify your specific plan's allowed amount before scheduling, as in-network rates vary significantly by carrier. Additionally, if you are paying out-of-pocket, you should explicitly request a "self-pay" or "prompt-pay" discount prior to check-in, as hospitals often offer uniform fee reductions for upfront payments that bypass administrative billing cycles and reduce overall costs.