Hip or knee replacement (inpatient stay)
Facility: Saint John Hospital
Billing Code: 470 (MS-DRG)
- CPT Billing Code: 470
- Insurance Median: $13,305
- Cash Discount Price: $12,855
- vs. Medicare Baseline: 0.95x 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 |
|---|---|---|
| Blue Cross Blue Shield | $11,076 - $22,152 | 79% |
| UnitedHealthcare | $11,641 - $17,998 | 83% |
| Medicaid / KanCare | $11,641 | 83% |
| Celtic | $11,874 - $17,355 | 85% |
| Healthy Blue | $11,874 - $13,498 | 85% |
| Cigna | $12,856 | 92% |
| Medicare (plans) | $12,856 | 92% |
| Midland Care Connection | $12,856 | 92% |
| Aetna | $12,856 - $19,891 | 92% |
| Tricare | $12,856 - $18,463 | 92% |
| Kansas Superior Select | $13,113 | 93% |
| Oha Networks | $14,095 | 100% |
| Worker Compensation | $14,530 | 103% |
| Employer Direct Healthcare | $16,712 | 119% |
| Well Path | $17,998 | 128% |
| Corizon | $17,998 | 128% |
| Centurion | $19,283 | 137% |
| Naphcare | $19,926 | 142% |
Consumer Guidance & Cost Commentary
For a hip or knee replacement at Saint John Hospital in Leavenworth, KS, the cash price is $12,855, which is lower than the state average of $14,044.15. While many insurance plans negotiate rates ranging from $11,076 to $19,926, these amounts often exceed the cash price due to administrative costs and contract structures. Patients with high-deductible plans may find it financially advantageous to pay the cash rate directly, as the insurance negotiated rate can sometimes be higher than the self-pay amount. To secure the lowest possible cost, it is recommended to contact the hospital directly to inquire about "self-pay" or "prompt-pay" discounts, which can further reduce the final bill.
When reviewing your statement, ensure you request a full itemized audit rather than accepting a summary bill, as over 80% of hospital bills contain errors such as unbundled codes or services not rendered. Comparing your facility's rates to the Medicare benchmark of $14,044.15 provides a clear view of the pricing baseline, as commercial negotiated rates often reflect a markup above this federal standard. If you receive a balance bill for out-of-network services, remember that the No Surprises Act protects you from paying the difference for emergency care and non-emergency services at in-network facilities. Always verify your deductible status before scheduling, as paying the negotiated rate without meeting your deductible can result in unexpected out-of-pocket expenses.