Hip or knee replacement (inpatient stay)
Facility: Saint Luke'S South Hospital
Billing Code: 470 (MS-DRG)
- CPT Billing Code: 470
- Insurance Median: $20,612
- Cash Discount Price: $52,022
- vs. Medicare Baseline: 1.47x 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 |
|---|---|---|
| Cigna | $1,777 - $45,020 | 13% |
| Humana | $2,200 | 16% |
| Transplants-Case Rates [5750] | $2,200 - $83,173 | 16% |
| Blue Cross Blue Shield | $3,360 - $62,513 | 24% |
| Commercial-Contracted [8000] | $3,857 - $20,717 | 27% |
| Medicaid / KanCare | $12,700 - $13,970 | 90% |
| Medicare (plans) | $12,948 - $13,595 | 92% |
| UnitedHealthcare | $18,996 - $31,285 | 135% |
| Aetna | $30,170 - $59,838 | 215% |
Consumer Guidance & Cost Commentary
For the hip or knee replacement procedure (inpatient stay) at Saint Luke's South Hospital in Overland Park, KS, the facility's cash median price is $52,022, which is significantly higher than the state average for this service. While Medicare sets a benchmark rate of $14,044 for this code, the facility's negotiated rates with major payers like Cigna and Blue Cross Blue Shield range from $1,777 to $62,513, reflecting the complex dynamics of insurance contracts. It is important to note that for patients with high-deductible plans, paying the cash price of $52,022 upfront can sometimes be more cost-effective than relying on insurance, as the negotiated rates paid by insurers often exceed the cash price due to administrative overhead and contract structures.
Patients should proactively inquire about "self-pay" or "prompt-pay" discounts before scheduling, as these programs can reduce the final bill by 20% to 50% by bypassing costly insurance claims processing. Although the facility offers a median negotiated rate of $20,612, this amount may still be subject to balance billing if your insurance does not cover the full cost, particularly if ancillary services are out-of-network. To ensure you are receiving the most accurate pricing, always request a detailed, itemized bill that breaks down every charge by CPT code rather than accepting a summary invoice, as over 80% of hospital bills contain errors such as double-billing or unbundled services that can be disputed to lower your debt.