Hip or knee replacement (inpatient stay)
Facility: Kansas Spine & Specialty Hospital, Llc
Billing Code: 470 (MS-DRG)
- CPT Billing Code: 470
- Insurance Median: $12,600
- Cash Discount Price: Unavailable
- vs. Medicare Baseline: 0.90x 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 |
|---|---|---|
| Humana | $12,348 | 88% |
| Blue Cross Blue Shield | $12,600 - $16,466 | 90% |
| United Mine Workers Of America | $12,600 | 90% |
| Providrs Care Network | $12,600 - $16,077 | 90% |
| UnitedHealthcare | $12,600 | 90% |
| Aetna | $12,600 - $16,758 | 90% |
| Lantern Specialty Care | $20,161 | 144% |
Consumer Guidance & Cost Commentary
For a hip or knee replacement at Kansas Spine & Specialty Hospital in Wichita, the negotiated rates for in-network insurance plans range from $12,348 to $16,758, with a median negotiated amount of $12,600. These commercial rates are significantly lower than the Medicare benchmark of $14,044.15, which serves as the federal baseline for the true cost of care. While commercial insurance contracts provide a ceiling to prevent balance billing for out-of-network services at this facility, patients should be aware that cash prices are often lower than these negotiated rates. If you have a high-deductible plan, paying the cash price directly might result in lower out-of-pocket costs compared to your insurance paying the negotiated rate and then requiring you to cover the remaining deductible.
To minimize your financial responsibility, it is advisable to contact the hospital directly to inquire about "self-pay" or "prompt-pay" discounts, which can reduce the total bill by 20% to 50% if settled upfront. Since over 80% of hospital bills contain errors, do not accept a summary bill as your final invoice; instead, request a detailed, itemized statement to verify that all charges are accurate and that no services were unbundled or double-billed. If you receive a bill that exceeds your insurance allowed amount, you may be eligible for a No Surprises Act audit to dispute any balance billing, ensuring you are only responsible for your deductible and copay rather than unexpected full charges.