CMS Price Transparency Data

Hip or knee replacement (inpatient stay)

Facility: La Palma Intercommunity Hospital

Billing Code: 470 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 470
Insurance Median: $18,826
Cash Discount Price: $18,826
vs. Medicare Baseline: 1.34x Medicare

The contracted insurance negotiated median rate for a Hip or knee replacement (inpatient stay) at La Palma Intercommunity Hospital is $18,826. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $18,826. Compared to the federal Medicare reimbursement reference rate of $14,044.15, this hospital’s rate is 1.34x the Medicare baseline. Located in 7901 Walker Street, La Palma, CA.

Cash / Self-Pay

$18,826

Average discount available for prompt cash payment at this facility.

Insurance Median

$18,826

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: $18,826 (134%)

Insurance Median: $18,826 (134%)

Cash: $18,826 (134% of Medicare)

Ins. Median: $18,826 (134% 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 Shield Of Promise	$18,826	134%
Blue Shiled Of Ca Triwest	$18,826	134%
Health Net Of Ca	$18,826 - $34,113	134%
La Care Health Plan	$18,826	134%
Managed Health Network	$18,826	134%
Medicare (plans)	$18,826	134%
Molina	$18,826	134%
Renal Payer Solutions	$18,826	134%
Tricare	$18,826 - $25,872	134%
Verda Healthplan	$18,826	134%
Brand New Day	$19,014	135%
Imperial Health Plan Of Ca	$19,956	142%
Employer Direct Healthcare	$24,474	174%
National Healthcare Solutions, Inc (Nhsi)	$30,122	214%
Aetna	$30,446	217%
Ca Foundation For Medical Care	$31,134	222%
Workers Compensation	$31,134	222%

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 $18,826.
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 La Palma Intercommunity 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.