Hip or knee replacement (inpatient stay)
Facility: Salina Regional Health Center
Billing Code: 470 (MS-DRG)
- CPT Billing Code: 470
- Insurance Median: $56,967
- Cash Discount Price: $44,308
- vs. Medicare Baseline: 4.06x 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.
Elevated Commercial Rate Alert (Value-Gap)
The negotiated rate at this facility is 406% of the Medicare baseline (a markup of 306%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.
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 |
|---|---|---|
| Blue Cross Blue Shield | $20,632 - $21,718 | 147% |
| Preferred Phsic | $37,978 | 270% |
| Preferred Healthcare - All Other Plans | $51,270 | 365% |
| Cigna | $56,967 | 406% |
| Multiplan (Mpi)-All Plans | $56,967 | 406% |
| Aetna | $56,967 | 406% |
| Providers Care (Wppa)-All Plans | $56,967 | 406% |
Consumer Guidance & Cost Commentary
For a hip or knee replacement at Salina Regional Health Center in Salina, KS, the facility's cash median rate of $44,308 is significantly lower than the negotiated rates paid by major insurers like Preferred Phsic ($37,978) and Aetna ($56,967). While the facility's negotiated rate of $56,967 aligns with the median paid across all payers, it is important to note that commercial rates often exceed cash prices due to administrative overhead and contract structures. Patients with high-deductible plans may find paying the cash price directly more cost-effective than relying on insurance, which could result in higher out-of-pocket costs if their deductible has not yet been met. Additionally, the facility offers a prompt-pay discount for upfront payment, which can further reduce the final bill compared to standard cash rates.
When evaluating this cost, it is crucial to compare the facility's pricing against the Medicare benchmark rather than the hospital's gross charges. The Medicare amount for this procedure is $14,044, and the facility's negotiated rate represents a markup relative to this federal baseline. If a patient receives care from an out-of-network provider or encounters unexpected ancillary services, they may face balance billing for the difference between the provider's full charge and the insurance allowed amount. To avoid these surprises, patients should request an itemized billing audit before paying, ensuring no unbundled codes or services not rendered are included in the final invoice. Always verify the facility's self-pay or prompt-pay discounts directly with the hospital prior to scheduling to secure the most favorable rate.