Hip or knee replacement (inpatient stay)
Facility: Baptist Health Lexington
Billing Code: 470 (MS-DRG)
- CPT Billing Code: 470
- Insurance Median: $23,787
- Cash Discount Price: $125,009
- vs. Medicare Baseline: 1.69x 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 |
|---|---|---|
| Wellcare Mcaid | $10,143 - $15,190 | 72% |
| Aetna | $10,959 - $81,607 | 78% |
| UnitedHealthcare | $11,076 - $57,178 | 79% |
| Blue Cross Blue Shield | $11,658 - $159,567 | 83% |
| Humana | $11,658 - $31,071 | 83% |
| Medicaid / KanCare | $11,658 | 83% |
| Molina Mcaid - All Plans | $11,658 - $12,152 | 83% |
| Sig Advantage - All Plans | $12,975 | 92% |
| Wellcare Mcr Adv - All Other Plans | $12,975 - $13,818 | 92% |
| Wellmark Mcr Adv - All Plans | $12,975 - $13,818 | 92% |
| Wellcare Med Adv - All Other Plans | $13,469 | 96% |
| Signature Adv - All Plans | $13,818 | 98% |
| Caresource Mcr Adv | $14,701 | 105% |
| Siho Exclusive Ntwrk | $16,781 | 119% |
| Siho Dual Ntwrk | $18,325 - $23,147 | 130% |
| Cigna | $19,274 - $24,003 | 137% |
| Siho Exclus Ntwrk | $19,289 | 137% |
| Ambetter / Centene | $22,052 | 157% |
| Caresource Just4Me - All Other Plans | $22,052 | 157% |
| Caresource-All Plans | $23,356 - $27,467 | 166% |
| Healthlink-All Plans | $23,664 - $23,911 | 168% |
| Siho Ppo - All Other Plans | $27,005 | 192% |
| Siho-All Plans | $27,005 - $92,032 | 192% |
| Center Care - All Plans | $30,182 | 215% |
| Center Care-All Plans | $31,843 - $183,671 | 227% |
| Mhs Mcaid - All Plans | $62,592 | 446% |
| Phcs-All Plans | $72,807 - $89,264 | 518% |
| Multiplan-All Plans | $74,776 - $126,058 | 532% |
| Encore Preferred | $80,582 | 574% |
| Multiplan/Phcs-All Plans | $120,075 | 855% |
| Encore Ppo - All Other Plans | $137,068 | 976% |