Hip or knee replacement (inpatient stay)
Facility: Rooks County Health Center
Billing Code: 470 (MS-DRG)
- CPT Billing Code: 470
- Insurance Median: $22,152
- Cash Discount Price: $28,747
- vs. Medicare Baseline: 1.58x 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 |
|---|---|---|
| Celtic Mcr Adv | $6,760 | 48% |
| Tricare | $6,760 | 48% |
| Veterans Admin - All Plans | $6,760 | 48% |
| Celtic Comm - All Other Plans | $7,436 | 53% |
| Healthy Blue Mcaid - All Plans | $10,421 | 74% |
| Blue Cross Blue Shield | $22,152 | 158% |
| Preferred Benefits Admin | $34,497 | 246% |
| Aetna | $34,497 | 246% |
| UnitedHealthcare | $34,497 | 246% |
| Preferred Hlthcare - All Other Plans | $36,413 | 259% |
| Health Partners - All Plans | $36,413 | 259% |
Consumer Guidance & Cost Commentary
For a hip or knee replacement at Rooks County Health Center in Plainville, Kansas, the facility's cash price of $28,747 is significantly lower than the median negotiated rates paid by major insurers like Blue Cross Blue Shield ($34,497) and Preferred Benefits Admin ($34,497). While the facility's cash rate is also lower than the state average for this procedure, patients with high-deductible plans may find paying out-of-pocket cheaper if their insurance allows a higher negotiated rate than the cash price. It is important to note that the facility is a Critical Access Hospital owned by a Government Hospital District, and while the cash rate is competitive, patients should explicitly ask about "self-pay" or "prompt-pay" discounts before scheduling to ensure they are receiving the lowest possible fee.
The Medicare benchmark for this service is $14,044, which serves as a baseline for evaluating the facility's pricing structure. The facility's cash rate of $28,747 represents a markup of approximately 1.6 times the Medicare amount, which aligns with typical commercial pricing dynamics where negotiated rates often range between 200% and 300% of Medicare due to administrative costs and contract structures. Patients should be aware that while the No Surprises Act protects against balance billing for out-of-network providers at in-network facilities, they should still request an itemized bill to verify all charges, as over 80% of hospital bills contain errors such as unbundled codes or services not rendered. Disputing these errors in writing is the most effective way to reduce unexpected medical debt.