CMS Price Transparency Data

Hip or knee replacement (inpatient stay)

Facility: Fresno Surgical Hospital

Billing Code: 470 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 470
Insurance Median: $16,454
Cash Discount Price: $14,594
vs. Medicare Baseline: 1.17x Medicare

The contracted insurance negotiated median rate for a Hip or knee replacement (inpatient stay) at Fresno Surgical Hospital is $16,454. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $14,594. Compared to the federal Medicare reimbursement reference rate of $14,044.15, this hospital’s rate is 1.17x the Medicare baseline. Located in 6125 North Fresno St, Fresno, CA.

Cash / Self-Pay

$14,594

Average discount available for prompt cash payment at this facility.

Insurance Median

$16,454

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: $14,594 (104%)

Insurance Median: $16,454 (117%)

Cash: $14,594 (104% of Medicare)

Ins. Median: $16,454 (117% 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
Aetna	$4,522 - $5,440	32%
Blue Shield Of Ca	$6,082	43%
Triwest	$13,359	95%
Cigna	$15,130	108%
Health Net	$17,778	127%
Meritage Medical Network	$17,778	127%
Humana	$18,187	129%
Sequoia Pace	$18,667	133%
Untied Healthcare	$21,850	156%

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 $14,594.
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 Fresno Surgical 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.