Hip or knee replacement (inpatient stay)
Facility: Via Christi Hospital Wichita St Teresa, Inc
Billing Code: 470 (MS-DRG)
- CPT Billing Code: 470
- Insurance Median: $11,337
- Cash Discount Price: Unavailable
- vs. Medicare Baseline: 0.81x 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 |
|---|---|---|
| Medica | $10,731 | 76% |
| Via Christi Research | $11,115 | 79% |
| Vc Hope | $11,115 | 79% |
| Saint Lukes Health Systems | $11,115 | 79% |
| Humana | $11,115 - $25,665 | 79% |
| Medicare (plans) | $11,115 - $11,337 | 79% |
| Va | $11,115 | 79% |
| UnitedHealthcare | $11,337 - $31,122 | 81% |
| Blue Cross Blue Shield | $11,337 | 81% |
| Aetna | $12,420 - $18,538 | 88% |
| Corizon | $13,894 | 99% |
| Smarthealth | $15,561 - $24,133 | 111% |
| Medicaid / KanCare | $18,896 | 135% |
| Healthchoice Of Ok | $21,277 | 152% |
Consumer Guidance & Cost Commentary
For the procedure code 470, representing a hip or knee replacement inpatient stay, the negotiated rates at Via Christi Hospital Wichita St Teresa, Inc range from $10,731 to $31,122 across 14 different payers. The median negotiated amount is $11,337, which is significantly lower than the Medicare benchmark of $14,044.15, indicating a markup of approximately 20% above the federal baseline. While the facility is a voluntary non-profit church-owned hospital in Wichita, KS (zip 67235), the data does not provide specific cash or state/county average figures for direct comparison. However, the wide variance in payer rates, such as the $18,896 rate for Medicaid/KanCare versus the $10,731 rate for Medica, highlights that insurance coverage type and plan specifics heavily influence the final cost.
Patients should be aware that insurance negotiated rates often exceed cash prices due to administrative overhead and contract structures, meaning paying out-of-pocket could sometimes result in a lower total bill if the patient has a high deductible. To secure the best possible price, it is essential to request a "self-pay" or "prompt-pay" discount before scheduling, as these upfront payment incentives can bypass costly claims processing and reduce the final amount by 20% to 50%. Additionally, because over 80% of hospital bills contain errors, patients should always demand a full itemized CPT-coded statement rather than accepting a summary bill, and they should verify their deductible status to ensure they are not unexpectedly responsible for the full negotiated rate.