Hip or knee replacement (inpatient stay)
Facility: Holton Community Hospital
Billing Code: 470 (MS-DRG)
- CPT Billing Code: 470
- Insurance Median: $11,434
- Cash Discount Price: $16,610
- vs. Medicare Baseline: 0.81x 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 |
|---|---|---|
| UnitedHealthcare | $1,433 - $11,434 | 10% |
| Aetna | $3,662 - $19,932 | 26% |
| Humana | $3,662 | 26% |
| Kansas Superior Select - All Plans | $3,735 | 27% |
| Wppa Providers - All Plans | $6,944 | 49% |
| Medicaid / KanCare | $11,434 | 81% |
| Preferred Health Freedom | $18,382 | 131% |
| Preferred Health Fn Select - All Other Plans | $18,382 | 131% |
| Preferred Health Professionals | $18,382 | 131% |
| Blue Cross Blue Shield | $21,718 | 155% |
Consumer Guidance & Cost Commentary
For the hip or knee replacement procedure at Holton Community Hospital in Holton, Kansas, the cash price of $16,610 is significantly lower than the negotiated rates charged by major payers like UnitedHealthcare ($1,433 to $11,434) and Aetna ($3,662 to $19,932). This facility, a Critical Access Hospital, charges a flat rate of $11,434 for Medicaid/KanCare plans, which aligns with the state average for this service. Because insurance negotiated rates often include administrative overhead and vary by plan, patients with high-deductible plans may find the cash price more affordable if their insurance allowed amount exceeds $16,610. To secure the lowest possible rate, patients should explicitly request a "self-pay" or "prompt-pay" discount before scheduling, as these upfront payment incentives can reduce the final bill by 20% to 50% and bypass costly insurance billing cycles.
The facility's cash price of $16,610 is also lower than the Medicare benchmark of $14,044.15 when adjusted for the specific cost structure of this Critical Access Hospital, though it remains below the gross charge of $22,147. While the median paid amount across all payers is $18,382, the negotiated rate of $11,434 represents the standard in-network payment for most commercial plans. Patients should be aware that balance billing is generally prohibited for emergency care and non-emergency services at in-network facilities under the No Surprises Act, but unexpected charges can still occur if ancillary services