CMS Price Transparency Data

Hip or knee replacement (inpatient stay)

Facility: Adventist Health Tehachapi Valley

Billing Code: 470 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 470
Insurance Median: $19,210
Cash Discount Price: $31,607
vs. Medicare Baseline: 1.37x Medicare

The contracted insurance negotiated median rate for a Hip or knee replacement (inpatient stay) at Adventist Health Tehachapi Valley is $19,210. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $31,607. Compared to the federal Medicare reimbursement reference rate of $14,044.15, this hospital’s rate is 1.37x the Medicare baseline. Located in 1100 Magellan, Tehachapi, CA.

Cash / Self-Pay

$31,607

Average discount available for prompt cash payment at this facility.

Insurance Median

$19,210

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: $31,607 (225%)

Insurance Median: $19,210 (137%)

Cash: $31,607 (225% of Medicare)

Ins. Median: $19,210 (137% 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	$2,475	18%
Blue Cross Blue Shield	$4,274 - $4,840	30%
Healthnet Medi-Cal	$4,286	31%
Klhp-Kern Legacy Epo -All Other Plans	$4,632	33%
Blue Shield Epn- All Other Plans	$6,654	47%
Blue Shield Non-Epn	$8,344	59%
Healthnet Mcare	$11,774	84%
Medicare (plans)	$11,774	84%
Tricare	$11,774	84%
UnitedHealthcare	$11,774 - $55,652	84%
Network Providers- All Plans	$15,071	107%
Oscar Health Plan- All Plans	$18,169	129%
Kaiser Ip/Op Only- All Other Plans	$20,251	144%
Centivo - All Plans	$26,492	189%
Healthnet- All Other Plans	$27,009	192%
Western Grwrs/Pinnacle - All Plans	$30,996	221%
Aetna	$36,825	262%
Kaiser Medi-Cal Ip/Op Only	$46,416	331%
Medi-Cal	$46,416	331%
Bc Mcal	$47,809	340%
Ah Employee Health Plan - All Plans	$62,044	442%
Khs-Kern Hlth Systm Mcal	$63,590	453%
Coventry- All Plans	$84,286	600%

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 $31,607.
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 Tehachapi Valley 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.