Hip or knee replacement, no major complications in San Francisco, CA: hospital prices

MS-DRG 470 is the inpatient stay for a hip or knee replacement without major complications: the operation, the implant, the hospital room and nursing care until discharge, usually one to three days. It is the single most common inpatient surgery in the US, and this DRG covers the great majority of joint replacements.

What the price covers

A DRG price is the hospital's charge for the whole stay: operating room, implant, room and board, nursing, medications, physical therapy in the hospital and supplies. It does not include the surgeon, the anesthesiologist, or rehabilitation after discharge, which are billed separately. Outpatient joint replacements, increasingly common for healthy patients, are billed with CPT codes instead and are often cheaper.

Why prices vary

Joint replacement prices at hospitals in the same metro area routinely differ by a factor of two to four for the same DRG. Implant contracts, system size and teaching status drive it. Many hospitals and surgeons offer a bundled cash price for the whole episode, including surgeon and anesthesia, that is below the sum of the parts.

Questions to ask

• What is the self-pay price for DRG 470, and what do surgeon and anesthesia add?
• Is a bundled price for the whole episode available?
• Am I a candidate for an outpatient replacement, and what does that cost?
• What happens to the price if I need an extra night?