Hip or knee replacement (inpatient stay)
Facility: Children'S Mercy South
Billing Code: 470 (MS-DRG)
- CPT Billing Code: 470
- Insurance Median: $10,178
- Cash Discount Price: Unavailable
- vs. Medicare Baseline: 0.72x 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 | $9,334 | 66% |
| Healthy Blue | $9,956 | 71% |
| Medicaid / KanCare | $10,401 | 74% |
| Blue Cross Blue Shield | $56,792 | 404% |
Consumer Guidance & Cost Commentary
For a self-pay patient, the most important first step is to explicitly request a "self-pay" or "prompt-pay" discount before scheduling your appointment or checking in. Hospitals often automatically submit claims to insurance carriers if a card is on file, which can void any upfront cash savings and trigger administrative fees; therefore, you should sign a waiver of insurance submission and ask for the specific cash rate prior to your visit. While the facility's cash median rate is not listed in this report, patients should be aware that paying in full upfront can sometimes result in lower costs compared to insurance negotiated rates, particularly for those with high-deductible plans where the insurer's allowed amount may exceed the cash price.
Regarding the broader rate context, the negotiated rates for this procedure at Children's Mercy South in Overland Park range from $9,334 to $56,792 depending on the payer, with the highest allowed amount for Blue Cross Blue Shield being $56,792. The median negotiated rate across all payers is $10,178, which is lower than the Medicare allowed amount of $14,044.15, reflecting the typical administrative load and contract dynamics that inflate commercial billing. Since no state or county average data was provided in this dataset, patients should rely on comparing the specific facility's negotiated rates directly against their own plan's allowed amounts and consider requesting an itemized billing audit to ensure no unbundled codes or services not rendered are included in the final invoice.