Hip or knee replacement (inpatient stay)
Facility: Wesley Medical Center
Billing Code: 470 (MS-DRG)
- CPT Billing Code: 470
- Insurance Median: $15,543
- Cash Discount Price: Unavailable
- vs. Medicare Baseline: 1.11x 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 |
|---|---|---|
| Usa Managed Care | $1,800 | 13% |
| United | $3,721 - $26,042 | 26% |
| UnitedHealthcare | $12,700 | 90% |
| Amerigroup | $13,208 | 94% |
| Aetna | $13,208 - $15,543 | 94% |
| First Health | $14,442 | 103% |
| Medicaid / KanCare | $14,885 | 106% |
| Wppa | $14,891 - $21,272 | 106% |
| Multiplan | $15,050 | 107% |
| Coventry Health Care | $15,543 | 111% |
| Humana | $15,543 | 111% |
| Devoted Health | $15,854 | 113% |
| Ambetter / Centene | $16,009 - $18,434 | 114% |
| Blue Cross Blue Shield | $22,650 | 161% |
| Correct Care Solutions | $23,314 | 166% |
Consumer Guidance & Cost Commentary
For a hip or knee replacement at Wesley Medical Center in Wichita, KS, the negotiated rates range from $1,800 to $23,314 depending on your specific insurance plan, with a median negotiated amount of $15,543. While commercial insurance contracts often result in higher costs due to administrative overhead and claim processing fees, cash-pay options can sometimes be more economical for patients with high-deductible plans, as the cash price may fall below the insurer's allowed amount. It is important to verify if your plan has a deductible that must be met before insurance coverage begins, as paying out-of-pocket might avoid these upfront costs. Additionally, patients should explicitly ask the hospital about "self-pay" or "prompt-pay" discounts, which can reduce the final bill by 20% to 50% if paid in full upfront, bypassing the costly insurance billing cycle.
This procedure is categorized under the MS-DRG code 470, and the facility's pricing is benchmarked against the Medicare rate of $14,044.15, which serves as the objective baseline for evaluating hospital markups. Commercial negotiated rates frequently exceed this federal standard, reflecting the multi-layered administrative structures inherent in private insurance contracts. To ensure you are not overpaying, always compare the facility's rates against state or county averages rather than the hospital's inflated chargemaster list. If you receive a bill after care, request a detailed, itemized statement to identify any errors, unbundled codes, or services not rendered, as over 80% of hospital bills contain discrepancies that can be corrected through a formal written audit dispute.