CMS Price Transparency Data

Hip or knee replacement (inpatient stay)

Facility: West Anaheim Medical Center

Billing Code: 470 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 470
Insurance Median: $19,798
Cash Discount Price: $19,669
vs. Medicare Baseline: 1.41x Medicare

The contracted insurance negotiated median rate for a Hip or knee replacement (inpatient stay) at West Anaheim Medical Center is $19,798. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $19,669. Compared to the federal Medicare reimbursement reference rate of $14,044.15, this hospital’s rate is 1.41x the Medicare baseline. Located in 3033 W Orange Avenue, Anaheim, CA.

Cash / Self-Pay

$19,669

Average discount available for prompt cash payment at this facility.

Insurance Median

$19,798

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: $19,669 (140%)

Insurance Median: $19,798 (141%)

Cash: $19,669 (140% of Medicare)

Ins. Median: $19,798 (141% 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
Blue Cross Blue Shield	$18,799	134%
Central Health Plan	$18,799	134%
Health Net Of Ca	$18,799 - $35,641	134%
Health Net Of Ca Mhn (Bh)	$18,799	134%
Managed Health Network	$18,799	134%
Molina	$18,799 - $19,669	134%
Renal Payor Solutions	$18,799	134%
Verda Health Plan	$18,799	134%
Brand New Day	$18,987	135%
Blue Shield Of Ca Triwest	$19,669	140%
Medicare (plans)	$19,669	140%
Imperial Health Plan Of Ca Inc	$19,927	142%
Health Net Federal Services	$24,587	175%
Employer Direct Healthcare Surgery Plus	$25,570	182%
Tricare	$27,452	195%
Naphcare (Santa Ana - County Jail)	$30,487	217%
Naphcare Residential Treatment Center	$30,487	217%
National Healthcare Solutions, Inc (Nhsi)	$31,471	224%
Ca Foundation For Medical Care	$32,952	235%
Workers Compensation	$32,952	235%
Aetna	$33,996	242%

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 $19,669.
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 West Anaheim 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.