Hip or knee replacement (inpatient stay)
Facility: Ventura County Medical Center
Billing Code: 470 (MS-DRG)
- CPT Billing Code: 470
- Insurance Median: $24,158
- Cash Discount Price: $49,246
- vs. Medicare Baseline: 1.72x 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.
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 |
|---|---|---|
| Hpn Ip/Op Only Medi-Cal | $14,537 | 104% |
| Kaiser Medi-Cal Ip/Op Only | $14,537 | 104% |
| Medi-Cal | $14,537 | 104% |
| Clinicas Mcal | $18,172 | 129% |
| Tricare | $20,365 | 145% |
| Aetna | $20,995 - $57,125 | 149% |
| Alignment Hp - All Plans | $20,995 | 149% |
| Blue Shield Mcr Adv | $20,995 | 149% |
| Humana | $20,995 | 149% |
| Medicare (plans) | $20,995 | 149% |
| Scan-All Plans | $20,995 | 149% |
| Blue Shield Comm - All Other Plans | $21,586 | 154% |
| UnitedHealthcare | $21,625 - $26,221 | 154% |
| Healthnet Mcr Adv | $22,045 | 157% |
| Gold Coast Medi-Cal-All Plans | $23,112 | 165% |
| Clinicas Mcr Adv | $23,934 | 170% |
| Blue Shield Epn | $24,158 | 172% |
| Americas Hp Mcal Ip/Op Only | $24,786 | 176% |
| Blue Cross Blue Shield | $27,105 | 193% |
| Clinicas Comm - All Other Plans | $27,294 | 194% |
| Imperial-All Plans | $27,294 | 194% |
| Ntwrk Provdrs-All Plans | $27,294 | 194% |
| Vchcp-All Plans | $27,578 | 196% |
| Cigna | $27,711 | 197% |
| Americas Hp Comm Ip/Op Only-All Other Plans | $28,343 | 202% |
| Hpn Comm Ip/Op Only-All Other Plans | $29,813 | 212% |
| Americas Hp Mcr Adv Ip/Op Only | $35,401 | 252% |
| Western Growers-All Plans | $37,572 | 268% |
| Healthnet Comm-All Other Plans | $54,170 | 386% |
| Multiplan/Claritev-All Plans | $78,793 | 561% |
| Three Rivers Ip/Op Only-All Plans | $78,793 | 561% |
| Ppo Next Ip/Op Only-All Plans | $88,643 | 631% |