CMS Price Transparency Data

Hip or knee replacement (inpatient stay)

Facility: Tri-City Medical Center

Billing Code: 470 (MS-DRG)

The BaseRate · fair price high confidence

A fair price for this

$20,677

about 1.5× the $14,044 Medicare rate · typically $17,929–$21,773

modeled estimate · not a bill or quote

What this hospital charges insurers

$18,936

About the fair price

about $1,741 under the fair price · 1.3× Medicare

Medicare pays $14,044 Fair price $20,677 This hospital $18,936

How we calculate the fair BaseRate →

How this hospital compares to other CA hospitals

Highest price of the 9 CA hospitals we have prices for — worth calling around.

Cheapest $9,517 Priciest $18,936

Black dot = this hospital, among the 9 CA hospitals with a price for this procedure. Full list below.

A fair price for a Hip or knee replacement (inpatient stay) is about $20,677 (about 1.5× the $14,044 Medicare rate). Tri-City Medical Center charges insurers about $18,936 — about the fair price. Located in Oceanside, CA.

What each insurance company pays

Which insurers have negotiated a price with this hospital for this procedure — and which haven’t.

5 of 6 major insurers have a published price at this hospital

✓ UnitedHealthcare✓ Blue Cross Blue Shield✓ Aetna✓ Humana✓ Kaiser Permanente Cigna

Crossed out = this hospital hasn’t published a negotiated price for that insurer for this procedure. It doesn’t necessarily mean they aren’t accepted — ask your insurer.

Insurance company	Price range	vs. Medicare
UnitedHealthcaremajor	$18,936	135%
Blue Cross Blue Shieldmajor	$18,936	135%
Aetnamajor	$18,936	135%
Humanamajor	$18,936	135%
Kaiser Permanentemajor	$18,936 - $32,192	135%
Health Net	$18,936 - $28,973	135%
Molina	$18,936 - $25,564	135%
Providence Health Plan	$26,511	189%
+ 7 smaller / regional plans	$18,936 - $28,405

Excludes 1 rental-network / third-party entry (e.g. Multiplan, PHCS) — these are pricing networks, not insurers.

Self-Pay How to get the cash price

Tell the billing desk you want to be billed as self-pay — not through insurance — before your visit.
Ask for the cash / prompt-pay discount in writing, with the exact price, before you agree to anything.
Get it in writing that they won’t also bill your insurance, so the cash price is what you owe.
Check the MS-DRG code on your bill matches exactly: 470.

Insurance Before you use insurance

Call your insurance company to confirm Tri-City Medical Center is in-network.
Ask your insurer whether prior approval is required for MS-DRG code 470.
Confirm the doctor or provider is in-network too — not just the hospital building.
Check your Explanation of Benefits against the hospital’s final itemized bill.

Estimate your out-of-pocket cost

A rough estimate of what you’d pay with insurance (deductible + coinsurance) versus paying the cash price yourself.

How you’d pay

Deductible left to meet ($)

Your coinsurance (%)

Enter your details and press estimate to compare.

Other Procedures at Tri-City Medical Center

Compare: Hip or knee replacement (inpatient stay) at other CA hospitals

Patients' Hospital of Redding · Redding $9,517
College Medical Center · Long Beach $12,743
Santa Clara Valley Medical Center · San Jose $15,669
Salinas Valley Memorial Hospital · Salinas $17,291
Shriners Hospitals for Children Northern Calif · Sacramento $17,574
French Hospital Medical Center · San Luis Obispo $17,727
Fresno Surgical Hospital · Fresno $17,982
Good Samaritan Hospital, LP · Bakersfield $18,197

Insurance negotiated median for the same procedure, sorted lowest first.