CMS Price Transparency Data

Hip or knee replacement (inpatient stay)

Facility: Adventist Health Tulare

Billing Code: 470 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 470
Insurance Median: $24,654
Cash Discount Price: $15,824
vs. Medicare Baseline: 1.76x Medicare

The contracted insurance negotiated median rate for a Hip or knee replacement (inpatient stay) at Adventist Health Tulare is $24,654. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $15,824. Compared to the federal Medicare reimbursement reference rate of $14,044.15, this hospital’s rate is 1.76x the Medicare baseline. Located in 869 North Cherry Street, Tulare, CA.

Cash / Self-Pay

$15,824

Average discount available for prompt cash payment at this facility.

Insurance Median

$24,654

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: $15,824 (113%)

Insurance Median: $24,654 (176%)

Cash: $15,824 (113% of Medicare)

Ins. Median: $24,654 (176% 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
Cigna	$8,450	60%
Blue Shield Epn	$9,784	70%
Blue Shield Mcare	$10,283	73%
Healthnet Hmo/Ppo - All Other Plans	$10,658	76%
Aetna	$13,270	94%
Blue Shield-All Other Plans	$13,579	97%
UnitedHealthcare	$14,569 - $19,836	104%
Fhcn Pace Mcr Adv - All Plans	$19,836	141%
Medicare (plans)	$19,836	141%
Prime Health - All Plans	$19,836	141%
Tricare	$19,836	141%
Bright Health - All Plans	$23,918	170%
Prison Hlthcre - All Plans	$25,390	181%
Network By Design-All Plans	$30,300	216%
Blue Cross Blue Shield	$30,852 - $46,362	220%
Hs Interplan-All Plans	$31,459	224%
Ah Employee Health Plan - All Plans	$35,704	254%
Incentive Hlth - All Plans	$35,704	254%
Cal Forensic Med Grp - All Plans	$39,727	283%
Healthnet Medi-Cal	$39,727	283%
Medi-Cal	$39,727	283%
Western Growers - All Plans	$50,463	359%
Ccipa Medi-Cal - All Plans	$51,645	368%
Multiplan - All Plans	$70,793	504%

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 $15,824.
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 Tulare 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.