CMS Price Transparency Data

Hip or knee replacement (inpatient stay)

Facility: Memorialcare Orange Coast Medical Center

Billing Code: 470 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 470
Insurance Median: $25,513
Cash Discount Price: Unavailable
vs. Medicare Baseline: 1.82x Medicare

The contracted insurance negotiated median rate for a Hip or knee replacement (inpatient stay) at Memorialcare Orange Coast Medical Center is $25,513. 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 1.82x the Medicare baseline. Located in 9920 Talbert Avenue, Fountain Valley, CA.

Cash / Self-Pay

Unavailable

Average discount available for prompt cash payment at this facility.

Insurance Median

$25,513

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: $25,513 (182%)

Ins. Median: $25,513 (182% 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
Monarch Health Plan	$18,295 - $41,213	130%
Blue Shield	$18,873 - $34,945	134%
Blue Cross Blue Shield	$19,258 - $44,460	137%
Citizens Choice	$19,258	137%
Healthcare Partners	$19,258 - $47,568	137%
Healthnet	$19,258 - $51,559	137%
Heritage Provider Network	$19,258	137%
Humana	$19,258	137%
La Care	$19,258	137%
Onecare	$19,258	137%
UnitedHealthcare	$19,258 - $55,011	137%
Wellcare	$19,258	137%
Molina	$19,836	141%
Clever Care	$20,221	144%
Universal Care	$20,221	144%
Central Health	$21,184	151%
Select Health	$25,999	185%
Aetna	$27,298 - $53,757	194%
Cigna	$37,229 - $58,522	265%
Centivo	$43,331	309%

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 Memorialcare Orange Coast 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.