Hip or knee replacement (inpatient stay)
Facility: Community Memorial Healthcare, Inc.
Billing Code: 470 (MS-DRG)
- CPT Billing Code: 470
- Insurance Median: $8,980
- Cash Discount Price: $33,134
- vs. Medicare Baseline: 0.64x 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 | $6,861 - $9,178 | 49% |
| UnitedHealthcare | $8,781 | 63% |
| Blue Cross Blue Shield | $22,152 | 158% |
Consumer Guidance & Cost Commentary
For a hip or knee replacement at Community Memorial Healthcare, Inc. in Marysville, KS, the cash median price is $33,134, which matches the facility's gross charge. This rate is significantly higher than the state average for this procedure, as the cash median is 60% of the Medicare benchmark amount of $14,044.15. While commercial insurance plans like Aetna, UnitedHealthcare, and Blue Cross Blue Shield negotiate rates ranging from $6,861 to $22,152, these figures often exceed the cash price for patients with high-deductible plans. In such cases, paying cash directly can be more cost-effective than relying on insurance, provided the patient has the funds available upfront.
To minimize costs, patients should proactively request a prompt-pay discount, which typically reduces the bill by 20% to 50% when paid in full before or shortly after the service. It is crucial to avoid accepting summary bills that obscure individual charges, as these often hide unbundled codes or services not rendered. Instead, demand a full itemized CPT-coded statement to identify any errors or double-billing before finalizing payment. Additionally, while the No Surprises Act protects against balance billing for out-of-network providers at in-network facilities, patients must verify their deductible status and ensure the hospital does not automatically submit claims that could void any cash discounts.