CMS Price Transparency Data

Hip or knee replacement (inpatient stay)

Facility: Sherman Oaks Hospital

Billing Code: 470 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 470
Insurance Median: $21,127
Cash Discount Price: $18,532
vs. Medicare Baseline: 1.50x Medicare

The contracted insurance negotiated median rate for a Hip or knee replacement (inpatient stay) at Sherman Oaks Hospital is $21,127. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $18,532. Compared to the federal Medicare reimbursement reference rate of $14,044.15, this hospital’s rate is 1.50x the Medicare baseline. Located in 4929 Van Nuys Blvd, Sherman Oaks, CA.

Cash / Self-Pay

$18,532

Average discount available for prompt cash payment at this facility.

Insurance Median

$21,127

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: $18,532 (132%)

Insurance Median: $21,127 (150%)

Cash: $18,532 (132% of Medicare)

Ins. Median: $21,127 (150% 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
Alignment	$18,532	132%
Elite Health Plan	$18,532	132%
Health Net Of Ca	$18,532 - $33,581	132%
Imperial Health Plan	$18,532	132%
L.A Care Health Plan	$18,532 - $18,533	132%
Managed Health Network	$18,532	132%
Molina	$18,532 - $18,533	132%
Renal Payer Solutions	$18,532	132%
Usa Senior Care Network	$18,532	132%
Aids Healthcare Foundation	$18,533 - $18,903	132%
Blue Shield Of Ca, Va	$18,533	132%
Medicare (plans)	$18,533	132%
Tricare	$18,533 - $26,059	132%
Brand New Day	$18,718	133%
Corvel	$21,127	150%
Zelis Healthcare	$21,127	150%
Aetna	$21,572	154%
Americas Choice Provider Network	$21,572	154%
Multiplan	$21,572	154%
Prime Health Services	$21,572	154%
Three Rivers	$21,572	154%
Healthsmart Preferred Network	$21,794	155%
Provider Select	$22,017	157%
Provider Network Of America	$22,239	158%
Employer Direct Healthcare	$24,092	172%
Naphcare	$28,725	205%
National Healthcare Solutions, Inc (Nhsi)	$29,652	211%
Ca Foundation For Medical Center	$32,256	230%
Worker Comp	$32,256	230%

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 $18,532.
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 Sherman Oaks 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.