Hip or knee replacement (inpatient stay)
Facility: Kansas Surgery & Recovery Center
Billing Code: 470 (MS-DRG)
- CPT Billing Code: 470
- Insurance Median: $16,802
- Cash Discount Price: $33,574
- vs. Medicare Baseline: 1.20x 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 |
|---|---|---|
| Blue Cross Blue Shield | $11,936 - $17,056 | 85% |
| Aetna | $11,937 - $21,610 | 85% |
| UnitedHealthcare | $12,174 - $16,547 | 87% |
| Cigna | $18,534 | 132% |
| Triwest | $19,833 | 141% |
Consumer Guidance & Cost Commentary
For a hip or knee replacement procedure at Kansas Surgery & Recovery Center in Wichita, the cash median price is $33,574, which is slightly lower than the facility's gross charge of $33,743. This cash rate is significantly lower than the commercial negotiated rates paid by major insurers, with Blue Cross Blue Shield, Aetna, and UnitedHealthcare paying between $11,936 and $21,610 depending on the specific plan. While these insurance payments appear lower than the cash price, patients with high-deductible plans may find the cash option more cost-effective if their out-of-pocket costs exceed the difference between the cash rate and the insurer's allowed amount. It is important to note that the facility does not have a publicly listed median paid amount, so individual patient costs will vary based on their specific insurance coverage and deductible status.
The facility's pricing structure is benchmarked against Medicare, which sets a baseline of $14,044.15 for this service. The cash rate represents approximately 124% of the Medicare amount, aligning with the generally accepted range for fair pricing (120% to 150% of Medicare) rather than the higher commercial markups often seen. Patients should be aware that hospitals frequently offer prompt-pay discounts, typically ranging from 20% to 50%, for those who settle their bill in full upfront. To secure these discounts, patients must request self-pay classification and sign a waiver preventing automatic claims submission before check-in, as billing systems often default to insurance processing once a card is on file. Additionally, under the No Surprises Act, patients are protected from balance billing for out