CMS Price Transparency Data

Hip or knee replacement (inpatient stay)

Facility: Adventist Health Delano

Billing Code: 470 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 470
Insurance Median: $20,934
Cash Discount Price: $10,769
vs. Medicare Baseline: 1.49x Medicare

The contracted insurance negotiated median rate for a Hip or knee replacement (inpatient stay) at Adventist Health Delano is $20,934. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $10,769. Compared to the federal Medicare reimbursement reference rate of $14,044.15, this hospital’s rate is 1.49x the Medicare baseline. Located in 1401 Garces Highway, Delano, CA.

Cash / Self-Pay

$10,769

Average discount available for prompt cash payment at this facility.

Insurance Median

$20,934

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: $10,769 (77%)

Insurance Median: $20,934 (149%)

Cash: $10,769 (77% of Medicare)

Ins. Median: $20,934 (149% 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
Gem Care- All Plans	$4,400	31%
County Of Kern Network - All Plans	$4,776	34%
UnitedHealthcare	$11,582 - $20,934	82%
Healthnet- All Other Plans	$12,853	92%
Aetna	$12,988	92%
Kern Health System Mcal	$14,415	103%
Western Growers - All Plans	$18,436	131%
Blue Shield Non-Epn	$19,190	137%
Bakersfield Fam Med Grp-All Plans	$20,934	149%
Healthnet Mcr Adv	$20,934	149%
Kern Mcr Adv Dual Dnsp-All Other Plans	$20,934	149%
Medicare (plans)	$20,934 - $33,495	149%
Tricare	$20,934	149%
Universal Care Mcr- All Other Plans	$20,934	149%
Blue Shield Epn - All Other Plans	$27,795	198%
Coventry- All Plans	$32,308	230%
Kaiser Comm Ip/Op Only- All Other Plans	$36,007	256%
Ah Employee Health Plan - All Plans	$37,682	268%
Kaiser Medi-Cal Ip/Op Only	$39,616	282%
Medi-Cal	$39,616	282%
Universal Care Mcal	$39,616	282%
Foundation For Medical Care Of Kern County - All Plans	$40,386	288%
Cigna	$43,078	307%
Blue Cross Blue Shield	$44,806 - $46,745	319%
Centivo - All Plans	$47,102	335%
Cirugia Sin Fornteras (Csf) - All Plans	$92,500	659%

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 $10,769.
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 Adventist Health Delano 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.