CMS Price Transparency Data

Hip or knee replacement (inpatient stay)

Facility: Adventist Health Twin Cities

Billing Code: 470 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 470
Insurance Median: $34,340
Cash Discount Price: $13,124
vs. Medicare Baseline: 2.45x Medicare

The contracted insurance negotiated median rate for a Hip or knee replacement (inpatient stay) at Adventist Health Twin Cities is $34,340. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $13,124. Compared to the federal Medicare reimbursement reference rate of $14,044.15, this hospital’s rate is 2.45x the Medicare baseline. Located in 1100 Las Tablas Rd, Templeton, CA.

Cash / Self-Pay

$13,124

Average discount available for prompt cash payment at this facility.

Insurance Median

$34,340

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: $13,124 (93%)

Insurance Median: $34,340 (245%)

Cash: $13,124 (93% of Medicare)

Ins. Median: $34,340 (245% 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.

Elevated Commercial Rate Alert (Value-Gap)

The negotiated rate at this facility is 245% of the Medicare baseline (a markup of 145%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.

Consult Patient Advocate

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
Aetna	$18,466 - $43,901	131%
Cencal Mcr Adv - All Other Plans	$18,466	131%
Tricare	$18,466	131%
UnitedHealthcare	$18,466 - $123,011	131%
Ccah-Centrl Ca Allince Mcal-All Plans	$23,281	166%
Medi-Cal	$23,416	167%
Coalinga-All Plans	$24,006	171%
Cencal Mcal	$26,695	190%
Hpn-Heritage Prov Ntwrk-All Plans	$27,343	195%
Blue Shield Promise Mcal	$28,146	200%
Ah Employee Health Plan - All Plans	$33,240	237%
Blue Shield Epn	$35,440	252%
Blue Shield Hmo/Pos	$40,555	289%
Blue Shield Epo/Ppo - All Other Plans	$47,768	340%
Nbd-Ntwrks By Design Exlus-All Other Plans	$50,787	362%
Nbd-Ntwrks By Design Non-Exlus	$53,945	384%
Chn-Community Hlth Ntwrk-All Plans	$149,984	1068%
Pacific Health Alliance-All Plans	$168,733	1201%

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 $13,124.
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 Twin Cities 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.