Hip or knee replacement (inpatient stay)
Facility: Menorah Medical Center
Billing Code: 470 (MS-DRG)
- CPT Billing Code: 470
- Insurance Median: $14,897
- Cash Discount Price: Unavailable
- vs. Medicare Baseline: 1.06x 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 |
|---|---|---|
| College Park Family Care Center | $2,022 | 14% |
| United | $2,428 - $43,819 | 17% |
| Humana | $4,466 - $14,897 | 32% |
| Multiplan | $6,522 - $14,822 | 46% |
| Medicaid / KanCare | $10,437 | 74% |
| Amerigroup | $12,700 | 90% |
| Healthyblue | $12,954 | 92% |
| Aetna | $13,208 - $37,353 | 94% |
| Unicare | $13,208 | 94% |
| Corvel Corporation | $14,442 | 103% |
| Coventry | $14,673 | 104% |
| Blue Cross Blue Shield | $14,748 - $56,184 | 105% |
| Oha Network | $15,050 | 107% |
| Devoted Health | $15,195 | 108% |
| Celtic | $15,195 | 108% |
| Wellcare | $15,195 | 108% |
| Nhc Advantage | $15,344 | 109% |
| Cigna | $15,493 - $42,953 | 110% |
| Pyramid Life | $16,387 | 117% |
| Universal Healthcare | $16,982 | 121% |
| Oscar | $20,986 | 149% |
| Ambetter / Centene | $21,797 | 155% |
| Wppa Providrs Care Network | $29,705 | 212% |
Consumer Guidance & Cost Commentary
For this procedure, the facility's negotiated rates range from $2,022 to $56,184 depending on the specific insurance plan, with a median negotiated amount of $14,897. It is important to note that cash payments can sometimes result in lower out-of-pocket costs for patients with high-deductible plans, as the cash median is not listed but is often lower than the insurance negotiated rates. To secure the best possible price, patients should explicitly ask the billing department about "self-pay" or "prompt-pay" discounts before scheduling, as these upfront fee reductions can significantly lower the final bill by bypassing administrative claim processing costs.
The facility's pricing is benchmarked against the national standard, showing a markup of 1.1 times the Medicare amount of $14,044.15 for this service. While the data does not provide specific county or state average comparisons for this exact code, understanding that commercial negotiated rates often average 200% to 300% of Medicare helps contextualize the facility's pricing structure. Patients should avoid accepting summary bills and instead request a full itemized audit to identify any unbundled codes or services not rendered, ensuring they are not paying for unnecessary charges.