Hip or knee replacement (inpatient stay)
Facility: Ascension Via Christi Hospital Manhattan, Inc
Billing Code: 470 (MS-DRG)
- CPT Billing Code: 470
- Insurance Median: $8,585
- Cash Discount Price: Unavailable
- vs. Medicare Baseline: 0.61x 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 | $8,176 | 58% |
| Medicaid / KanCare | $8,504 - $8,585 | 61% |
| Aetna | $8,504 | 61% |
| Smarthealth | $17,880 | 127% |
| Blue Cross Blue Shield | $23,991 - $25,253 | 171% |
Consumer Guidance & Cost Commentary
For a hip or knee replacement at Ascension Via Christi Hospital Manhattan, Inc, the negotiated rates for major payers like Medicaid/KanCare and Aetna range from $8,504 to $8,585, while Blue Cross Blue Shield rates are significantly higher, between $23,991 and $25,253. These commercial rates are notably higher than the Medicare benchmark of $14,044.15, which serves as a scientifically validated baseline for the true cost of care. While the facility offers a 4-star rating, patients should be aware that cash-pay options are often more affordable than insurance negotiated rates; if your plan has a high deductible, paying out-of-pocket may result in lower total costs, provided you confirm the facility's self-pay or prompt-pay discounts before scheduling.
It is critical to avoid balance billing surprises, as federal protections under the No Surprises Act generally prevent hospitals from charging patients the difference between the insurer's allowed amount and the facility's full chargemaster rate for out-of-network services at in-network facilities. Furthermore, patients should never accept a summary bill as the final invoice; instead, request a detailed, itemized statement to identify any unbundled codes or services not rendered, as over 80% of hospital bills contain errors that can be corrected through a formal written audit dispute. By comparing these specific negotiated amounts directly to the Medicare rate and actively seeking prompt-pay discounts, you can ensure you are paying a fair price that aligns with the facility's actual cost structure rather than inflated administrative markups.