Hip or knee replacement (inpatient stay)
Facility: St. Catherine Hospital - Garden City
Billing Code: 470 (MS-DRG)
- CPT Billing Code: 470
- Insurance Median: $20,187
- Cash Discount Price: Unavailable
- vs. Medicare Baseline: 1.44x 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 | $14,342 - $43,881 | 102% |
| Aetna | $14,490 - $45,495 | 103% |
| Blue Cross Blue Shield | $14,490 - $30,140 | 103% |
| Innovage | $14,490 | 103% |
| Humana | $14,490 - $20,187 | 103% |
| Cigna | $14,490 - $50,361 | 103% |
| Devoted Health | $14,490 | 103% |
| Kaiser | $14,490 - $21,395 | 103% |
| Medicare (plans) | $14,490 - $20,187 | 103% |
| Kansas Health | $20,187 | 144% |
| Peak Health | $21,005 | 150% |
| Direct To Employer | $24,532 - $25,435 | 175% |
| United Colorado Doctor'S Plan | $28,371 | 202% |
Consumer Guidance & Cost Commentary
For the hip or knee replacement procedure at St. Catherine Hospital in Garden City, Kansas, the negotiated rates across 13 insurance plans range from $14,490 to $50,361, with a median negotiated amount of $20,187. This commercial rate is significantly higher than the Medicare benchmark of $14,044.15, reflecting a markup of 1.4 times the federal baseline. While commercial insurance contracts often include administrative overhead that inflates prices by 20% to 40%, patients with high-deductible plans may find that paying the cash price directly is more cost-effective, as the cash rate can sometimes be lower than the insurance negotiated amount. It is important to note that cash-pay options are not explicitly listed in the current data, so patients should contact the hospital directly to inquire about self-pay or prompt-pay discounts before scheduling.
The facility's pricing structure is anchored by the Medicare rate, which serves as the objective cost baseline for evaluating markups, rather than the hospital's inflated chargemaster list. In this case, the median negotiated rate of $20,187 exceeds the state and county averages, indicating that the facility's commercial contracts are priced above the typical regional standard. To ensure you are receiving the best possible price, verify your specific plan's allowed amount and check for any prompt-pay incentives that could reduce the final bill. If you receive an itemized bill, review it carefully for errors or unbundled codes, as over 80% of hospital bills contain discrepancies that can be resolved through a formal audit. Always confirm whether your specific insurance plan has met its deductible before assuming the negotiated rate will apply,