Hip or knee replacement (inpatient stay)
Facility: Select Specialty Hospital - Kansas City
Billing Code: 470 (MS-DRG)
- CPT Billing Code: 470
- Insurance Median: $1,700
- Cash Discount Price: Unavailable
- vs. Medicare Baseline: 0.12x 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 |
|---|---|---|
| Aetna | $1,615 - $1,880 | 11% |
| Cigna | $1,682 | 12% |
| Phcs-Multiplan | $1,700 | 12% |
| Wppa | $1,801 | 13% |
| UnitedHealthcare | $1,836 | 13% |
| Healthcare Highways | $1,957 | 14% |
| Sidecare Health Insurance Solutions | $2,000 | 14% |
Consumer Guidance & Cost Commentary
For the procedure "Hip or knee replacement (inpatient stay)" at Select Specialty Hospital - Kansas City, the negotiated rates for in-network insurance plans range from $1,615 to $2,000, with a median negotiated amount of $1,700. These commercial rates are significantly lower than the Medicare benchmark of $14,044.15, reflecting the standard pricing dynamics where commercial contracts cap charges well below federal reimbursement levels. While the data does not provide specific cash or self-pay rates, patients with high-deductible plans should be aware that paying out-of-pocket upfront can sometimes result in a lower total cost if the facility offers a prompt-pay discount, which typically reduces bills by 20% to 50% for immediate payment. It is crucial to request self-pay classification and prompt-pay rates before check-in and to sign a waiver of insurance submission to ensure the cash discount applies rather than triggering an insurance claim.
This facility is located in Kansas City, KS (ZIP 66112), and while the provided data does not include specific county or state average comparisons for this specific DRG, the facility operates as a Part A Provider Hospital. The absence of a listed cash median suggests that the final out-of-pocket cost will depend entirely on the patient's specific insurance plan and any negotiated discounts available. To avoid unexpected balance billing, patients should verify their network status and ensure they do not sign out-of-network cost waivers for emergency or mandatory ancillary services, as the No Surprises Act protects against balance billing for out-of-network providers at in-network facilities. Finally, if a large bill is received, patients should demand a full itemized CPT-coded statement to identify any