CMS Price Transparency Data

Hip or knee replacement (inpatient stay)

Facility: Antelope Valley Hospital

Billing Code: 470 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 470
Insurance Median: $20,477
Cash Discount Price: Unavailable
vs. Medicare Baseline: 1.46x Medicare

The contracted insurance negotiated median rate for a Hip or knee replacement (inpatient stay) at Antelope Valley Hospital is $20,477. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is unavailable. Compared to the federal Medicare reimbursement reference rate of $14,044.15, this hospital’s rate is 1.46x the Medicare baseline. Located in 1600 W Ave J, Lancaster, CA.

Cash / Self-Pay

Unavailable

Average discount available for prompt cash payment at this facility.

Insurance Median

$20,477

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%)

Insurance Median: $20,477 (146%)

Ins. Median: $20,477 (146% 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
Brand New Day - Medi	$2,207	16%
Blue Cross Blue Shield	$2,366	17%
Blue Shield Of California	$2,370	17%
L.A. Care Health Plan - Medi	$2,500	18%
L.A. Care Health Plan - Pasc	$2,500	18%
Community Family Care Health Plan - Med	$2,600	19%
Heritage Provider Network	$3,447	25%
Aetna	$20,477	146%
Alignment Healthcare	$20,477	146%
Central Health Plan Of California	$20,477	146%
Citizens Choice Healthplan	$20,477	146%
Health Net Of California	$20,477 - $30,716	146%
L.A. Care Health Plan	$20,477	146%
Managed Health Network (Mental Health)	$20,477	146%
Wellcare	$20,477	146%
Humana	$20,887	149%
For Your Benefit	$21,092	150%
Brand New Day	$21,501	153%
Champion Health Plan	$21,501	153%
Aids Foundation	$23,549	168%
Align Senior Care Ca	$23,549	168%
Clever Care Health Plan	$24,573	175%
Blue Shield	$26,063	186%
Ca State Prison	$26,621	190%
Oscar Hp/Providence Health Network	$30,716	219%

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 $X.
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 Antelope Valley Hospital 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.