Hip or knee replacement (inpatient stay)
Facility: Wamego Health Center
Billing Code: 470 (MS-DRG)
- CPT Billing Code: 470
- Insurance Median: $8,585
- Cash Discount Price: Unavailable
- vs. Medicare Baseline: 0.61x 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 |
|---|---|---|
| UnitedHealthcare | $8,176 | 58% |
| Medicaid / KanCare | $8,504 - $8,585 | 61% |
| Aetna | $16,587 | 118% |
| Blue Cross Blue Shield | $29,094 - $30,625 | 207% |
Consumer Guidance & Cost Commentary
For a hip or knee replacement at Wamego Health Center in Wamego, Kansas, the negotiated rates for in-network payers range from $8,176 to $30,625, with a median negotiated amount of $8,585. This facility, a Critical Access Hospital, does not have publicly available cash or median paid rates listed, but patients should be aware that cash-pay options can sometimes be more cost-effective than insurance negotiated rates, particularly for those with high-deductible plans. Since commercial insurance contracts often include administrative overheads that inflate the baseline price, it is advisable to explicitly ask the hospital about "self-pay" or "prompt-pay" discounts before scheduling, as these upfront fee reductions can significantly lower the final cost.
The pricing for this service is benchmarked against the Medicare rate of $14,044.15, which serves as the federal baseline for healthcare costs. While the specific county or state average for this procedure is not provided in the current data, the facility's negotiated rates for major payers like Medicaid/KanCare and Aetna fall below the Medicare amount, suggesting a competitive pricing structure relative to the government standard. To ensure you are receiving the best possible price, always request a full itemized bill rather than accepting a summary invoice, as detailed line-by-line statements help identify any unbundled charges or services not rendered. Additionally, if you have out-of-network services on your bill, you may be protected under the No Surprises Act, which prevents balance billing for emergency care and non-emergency services at in-network facilities.