CMS Price Transparency Data

Hip or knee replacement (inpatient stay)

Facility: Los Robles Hospital & Medical Center

Billing Code: 470 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 470
Insurance Median: $21,264
Cash Discount Price: Unavailable
vs. Medicare Baseline: 1.51x Medicare

The contracted insurance negotiated median rate for a Hip or knee replacement (inpatient stay) at Los Robles Hospital & Medical Center is $21,264. 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 1.51x the Medicare baseline. Located in 215 W Janss Rd, Thousand Oaks, CA.

Cash / Self-Pay

Unavailable

Average discount available for prompt cash payment at this facility.

Insurance Median

$21,264

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: $21,264 (151%)

Ins. Median: $21,264 (151% 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
Gold Coast Health Plan	$1,579	11%
Ppo Next	$2,222	16%
First Health	$2,768 - $3,785	20%
Onelegacy	$3,000	21%
Health Net	$4,784 - $23,276	34%
Cigna	$5,314 - $77,706	38%
Blue Shield	$6,539 - $21,689	47%
United	$8,666 - $55,692	62%
Assisted Hospice Care	$17,011	121%
Mission Hh Hospice	$17,011	121%
Vitas Healthcare	$17,011	121%
Bright Health	$18,544 - $24,467	132%
Brand New Day	$20,838 - $31,896	148%
Aetna	$21,264 - $33,294	151%
Alignment Health Plan	$21,264	151%
Blue Cross Blue Shield	$21,264 - $48,685	151%
Buena Vista Hospice	$21,264	151%
Central Health Plan	$21,264	151%
Clever Care Of Golden State	$21,264 - $22,327	151%
Easy Choice Health Plan	$21,264	151%
Humana	$21,264	151%
La Care	$21,264	151%
Medcare Partners	$21,264 - $22,327	151%
Scan Health Plan	$21,264	151%
Tender Loving Care	$21,264	151%
Triwest Healthcare Alliance	$21,264	151%
Care1St Health Plan	$21,689	154%
Corvel Corporation	$28,003	199%
Ventura County Foundation	$28,286	201%

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 Los Robles Hospital & 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.