Hip or knee replacement (inpatient stay)
Facility: Stormont Vail Hospital
Billing Code: 470 (MS-DRG)
- CPT Billing Code: 470
- Insurance Median: $14,084
- Cash Discount Price: Unavailable
- vs. Medicare Baseline: 1.00x 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 | $11,659 - $22,983 | 83% |
| Ambetter / Centene | $11,659 - $22,983 | 83% |
| Blue Cross Blue Shield | $11,773 - $45,500 | 84% |
| Aetna | $12,625 - $14,084 | 90% |
| Humana | $12,625 - $14,084 | 90% |
Consumer Guidance & Cost Commentary
For the procedure "Hip or knee replacement (inpatient stay)" at Stormont Vail Hospital in Topeka, KS, commercial insurance rates vary significantly depending on your specific plan. While UnitedHealthcare and Ambetter / Centene have a low-end range starting at $11,659, Blue Cross Blue Shield offers a much wider band, with some plans reaching up to $45,500. It is important to note that cash-pay rates are not listed for this service, so patients with high-deductible plans should verify if paying out-of-pocket is more cost-effective than using insurance, as commercial negotiated rates often exceed cash prices when administrative overhead is factored in.
This facility's pricing is benchmarked against the Medicare rate of $14,044.15, which serves as the objective baseline for evaluating hospital markups. The median negotiated rate of $14,084 aligns closely with the Medicare amount, suggesting a pricing structure that adheres to fair value standards rather than inflating charges based on the hospital's gross chargemaster list. Since this is an in-network facility, balance billing for out-of-network ancillary services is unlikely to occur under the No Surprises Act, but patients should still request an itemized bill to ensure no unbundled codes or services not rendered have been charged.