CMS Price Transparency Data

Hip or knee replacement (inpatient stay)

Facility: Riverview Regional Medical Center

Billing Code: 470 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 470
Insurance Median: $12,932
Cash Discount Price: $12,867
vs. Medicare Baseline: 0.92x Medicare

The contracted insurance negotiated median rate for a Hip or knee replacement (inpatient stay) at Riverview Regional Medical Center is $12,932. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $12,867. Compared to the federal Medicare reimbursement reference rate of $14,044.15, this hospital’s rate is 0.92x the Medicare baseline. Located in 600 South Third Street, Gadsden, AL.

Cash / Self-Pay

$12,867

Average discount available for prompt cash payment at this facility.

Insurance Median

$12,932

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$14,044.15

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $14,044.15 (100%)

Cash / Self-Pay: $12,867 (92%)

Insurance Median: $12,932 (92%)

Cash: $12,867 (92% of Medicare)

Ins. Median: $12,932 (92% of 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.

Billing Status

Remaining Deductible ($)

Your Coinsurance Rate (%)

Input your details and click calculate to compare out-of-pocket costs.

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	$3,407 - $12,868	24%
Corvel	$4,058	29%
Occunet	$4,279 - $19,301	30%
Blue Cross Blue Shield	$12,482 - $12,868	89%
Viva Health	$12,739	91%
Cigna	$12,868 - $23,382	92%
Evernorth Behavioral Health	$12,868	92%
Medicare (plans)	$12,868	92%
Simpra Advantage	$12,996	93%
Devoted Health	$13,125	93%
Employer Direct Healthcare	$16,728	119%
Tricare	$17,607	125%
Humana	$18,520	132%
Aetna	$19,301	137%
Health Choice Of Alabama (Healthnet)	$19,945	142%
Naphcare	$19,945	142%
National Healthcare Solutions, Inc	$20,588	147%

Self-Pay Upfront Cash Action Plan

Request a "Self-Pay classification" with the billing desk before receiving care.
Ask for a written "Prompt-Pay Discount" agreement quoting the price of $12,867.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify MS-DRG Code matches exactly: 470.

Insurance In-Network Protection Plan

Contact your insurance company to confirm Riverview Regional Medical Center is fully in-network.
Ask your insurer if "Prior Authorization" is required for MS-DRG code 470.
Confirm the specific physician or imaging center is also in-network (not just the hospital building).
Audit your Explanation of Benefits (EOB) against the final itemized hospital invoice.