Hip or knee replacement (inpatient stay)
Facility: Pratt Regional Medical Center
Billing Code: 470 (MS-DRG)
- CPT Billing Code: 470
- Insurance Median: $31,782
- Cash Discount Price: $26,739
- vs. Medicare Baseline: 2.26x 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 226% of the Medicare baseline (a markup of 126%). 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 |
|---|---|---|
| Providrs Care | $21,009 | 150% |
| Christian Health Aid | $28,649 | 204% |
| Aetna | $30,559 | 218% |
| UnitedHealthcare | $31,782 - $38,963 | 226% |
| Health Partners Of Kansas | $32,469 | 231% |
| Choicecare | $38,199 | 272% |
Consumer Guidance & Cost Commentary
For a hip or knee replacement at Pratt Regional Medical Center in Pratt, KS, the cash median price is $26,739, which is lower than the facility's gross charge of $38,199. While the facility's negotiated rates with major payers like UnitedHealthcare and Aetna range from $30,559 to $38,963, patients with high-deductible plans might find paying cash directly more cost-effective, as the cash price is significantly lower than the insurer's allowed amount. It is important to note that commercial negotiated rates often include administrative overhead and can exceed the true cost of care; comparing these rates to the Medicare benchmark of $14,044 reveals a substantial markup, suggesting that the facility's pricing structure is well above the federal baseline.
To ensure you are not overcharged, you should request a full itemized bill before finalizing payment, as summary invoices can obscure errors or unbundled charges that inflate the total. If you receive a balance bill for services rendered at an in-network facility, you may have protections under the No Surprises Act, which bans balance billing for out-of-network providers in emergency or non-emergency settings. Additionally, ask the billing department about prompt-pay discounts, which can reduce the final amount by 20% to 50% if you settle the account in full upfront, effectively bypassing the administrative costs associated with insurance claims processing.