Hip or knee replacement (inpatient stay)
Facility: Clara Barton Hospital
Billing Code: 470 (MS-DRG)
- CPT Billing Code: 470
- Insurance Median: $33,546
- Cash Discount Price: $26,091
- vs. Medicare Baseline: 2.39x 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 239% of the Medicare baseline (a markup of 139%). 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 |
|---|---|---|
| Blue Cross Blue Shield | $21,718 | 155% |
| 6 Degrees Health - All Plans | $26,091 | 186% |
| Wppa-All Plans | $29,819 | 212% |
| Phcs - All Plans | $33,546 | 239% |
| UnitedHealthcare | $33,546 | 239% |
| Aetna | $33,546 | 239% |
| Hlth Partners Of Ks-All Plans | $34,291 | 244% |
Consumer Guidance & Cost Commentary
For a hip or knee replacement at Clara Barton Hospital in Hoisington, KS, the cash price is $26,091, which is lower than the negotiated rates of $33,546 paid by major insurers like Aetna, UnitedHealthcare, and Blue Cross Blue Shield. While commercial insurance contracts often result in higher out-of-pocket costs due to administrative fees and claim processing, paying cash upfront can be a more affordable option for patients with high-deductible plans or those without coverage. The facility offers a prompt-pay discount for immediate payment, which can further reduce the final bill, so it is advisable to ask about self-pay rates and request a waiver of insurance submission before scheduling to avoid automatic claims that may void the cash agreement.
This procedure's cash price is significantly lower than the Medicare benchmark of $14,044, indicating a markup relative to the federal government's cost-based reimbursement rate. Although the facility is a Critical Access Hospital with a voluntary non-profit ownership structure, the negotiated rates across seven payers range from $21,718 to $34,291, reflecting the variability in commercial contracts. 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 they should still request an itemized bill to verify that all charges are accurate and that no unbundled codes or services not rendered have inflated the total.