Hip or knee replacement (inpatient stay)
Facility: Kansas City Orthopaedic Institute
Billing Code: 470 (MS-DRG)
- CPT Billing Code: 470
- Insurance Median: $16,608
- Cash Discount Price: Unavailable
- vs. Medicare Baseline: 1.18x 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 | $12,624 - $16,415 | 90% |
| Aetna | $12,624 | 90% |
| UnitedHealthcare | $12,624 - $18,020 | 90% |
| Blue Cross Blue Shield | $13,891 - $23,690 | 99% |
| Medica | $16,800 | 120% |
| Self Pay | $19,420 | 138% |
Consumer Guidance & Cost Commentary
For a hip or knee replacement at the Kansas City Orthopaedic Institute in Leawood, KS, the negotiated rates for in-network payers range from $12,624 to $23,690, with a median negotiated amount of $16,608. While commercial insurance contracts cap these costs, the facility offers a self-pay rate of $19,420, which is notably higher than the cash median often seen in the market. Patients with high-deductible plans should be aware that paying out-of-pocket upfront can sometimes be more cost-effective than relying on insurance, especially if the negotiated rate exceeds the cash price. It is crucial to verify your specific plan's deductible status before scheduling, as paying the full negotiated amount may not be covered until that threshold is met.
To ensure you are not overcharged, always request a detailed itemized bill before finalizing payment, as summary invoices can obscure individual line items and potential errors. Since over 80% of hospital bills contain mistakes, such as unbundled codes or services not rendered, a formal written audit dispute sent to the billing supervisor is the most effective way to reduce medical debt. Additionally, while balance billing is generally prohibited for in-network care under the No Surprises Act, patients should confirm their network status and avoid signing out-of-network waivers for emergency services. Finally, consider asking the hospital about prompt-pay discounts, which can reduce the total cost by 20% to 50% if paid in full within 30 days, bypassing the administrative costs associated with insurance claims processing.