Hip or knee replacement (inpatient stay)
Facility: Providence Medical Center
Billing Code: 470 (MS-DRG)
- CPT Billing Code: 470
- Insurance Median: $15,159
- Cash Discount Price: $14,436
- vs. Medicare Baseline: 1.08x 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 |
|---|---|---|
| Medicaid / KanCare | $12,680 | 90% |
| UnitedHealthcare | $12,680 - $20,788 | 90% |
| Healthy Blue | $12,934 - $15,159 | 92% |
| Aetna | $12,934 - $23,639 | 92% |
| Celtic | $12,934 - $19,490 | 92% |
| Oha Networks | $14,095 | 100% |
| Blue Cross Blue Shield | $14,177 - $22,612 | 101% |
| Midland Care Connection | $14,437 | 103% |
| Cigna | $14,437 | 103% |
| Tricare | $14,437 - $18,645 | 103% |
| Medicare (plans) | $14,437 | 103% |
| Worker Compensation | $14,530 | 103% |
| Kansas Superior Select | $15,159 | 108% |
| Employer Direct Healthcare | $18,768 | 134% |
| Corizon | $18,768 | 134% |
| Well Path Prison | $20,211 | 144% |
| Centurion | $21,655 | 154% |
| Naphcare | $22,377 | 159% |
Consumer Guidance & Cost Commentary
For a hip or knee replacement at Providence Medical Center in Kansas City, KS, the cash price is $14,436, which is slightly lower than the state average of $14,437. While commercial insurance plans like UnitedHealthcare and Aetna negotiate rates ranging from $12,680 to $23,639, these figures often exceed the cash price due to administrative overhead and contract structures. Because commercial negotiated rates can be higher than the cash rate, patients with high-deductible plans may find it financially advantageous to pay the cash price directly, provided they verify the facility's "self-pay" or "prompt-pay" discounts before scheduling.
The facility's Medicare benchmark of $14,044 serves as a scientifically validated baseline for evaluating pricing markups, representing the true cost of care rather than inflated chargemaster lists. Commercial rates for this procedure average between 100% and 160% of the Medicare amount, with some payer plans negotiating rates significantly above the fair pricing range of 120% to 150% of Medicare. To ensure you are not overpaying, it is essential to request an itemized billing audit to identify any unbundled codes or services not rendered, and to confirm that any negotiated rates align with the facility's actual cost basis before finalizing treatment.