Hip or knee replacement (inpatient stay)
Facility: Scott County Hospital
Billing Code: 470 (MS-DRG)
- CPT Billing Code: 470
- Insurance Median: $5,810
- Cash Discount Price: Unavailable
- vs. Medicare Baseline: 0.41x 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 | $10,421 | 74% |
Consumer Guidance & Cost Commentary
For a hip or knee replacement at Scott County Hospital in Scott City, Kansas, the negotiated rate of $5,810 is significantly lower than the state average, offering a more affordable option for in-network patients. While the facility is a Critical Access Hospital with a voluntary non-profit ownership structure, it is important to note that cash-pay rates are not available for this service. However, patients with high-deductible plans should be aware that paying cash can sometimes be cheaper than insurance if the negotiated rate exceeds the cash price; in this specific case, since no cash median is listed, patients should directly contact the hospital to inquire about self-pay or prompt-pay discounts before scheduling.
This procedure is billed under MS-DRG code 470, and while the facility has a Medicare benchmark of $14,044.15, the actual negotiated payment is $5,810.00, reflecting a substantial difference from the federal baseline. If you are concerned about balance billing or unexpected charges, remember that the No Surprises Act protects you from being billed the difference between the hospital's full chargemaster and your insurance allowed amount for out-of-network providers at in-network facilities. To ensure you are not overcharged, always request a full itemized bill before paying, as summary bills may hide unbundled codes or services not rendered, and dispute any errors in writing rather than accepting verbal assurances.