CMS Price Transparency Data

Hip or knee replacement (inpatient stay)

Facility: Children's Hosp of Los Angeles

Billing Code: 470 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 470
Insurance Median: $10,000
Cash Discount Price: Unavailable
vs. Medicare Baseline: 0.71x Medicare

The contracted insurance negotiated median rate for a Hip or knee replacement (inpatient stay) at Children's Hosp of Los Angeles is $10,000. 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 0.71x the Medicare baseline. Located in 4650 Sunset Blvd, Ms 108, Los Angeles, CA.

Cash / Self-Pay

Unavailable

Average discount available for prompt cash payment at this facility.

Insurance Median

$10,000

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: $10,000 (71%)

Ins. Median: $10,000 (71% 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
Altamed	$3,000	21%
Health Net	$3,213 - $4,405	23%
Blue Cross Blue Shield	$3,285 - $4,593	23%
UnitedHealthcare	$3,535 - $25,063	25%
Managed Care Systems	$3,539	25%
Interlink Health Services	$4,419	31%
Heritage Provider Network	$4,447 - $4,833	32%
Blue Shield	$5,286	38%
Medicare (plans)	$6,507	46%
Beech Street	$10,000	71%
Private Hlthcare System	$10,000	71%
Ventura County Health Plan	$13,298	95%
Alhambra Hospital Medical Center	$13,926	99%
Aetna	$22,810	162%
Intl - Global Excel Management	$23,621	168%
Intl - Aixin Life Insurance Co	$27,601	197%
Intl - Erv Travel Services	$27,601	197%
Intl - Quality Health Management	$27,601	197%
Cigna	$28,055	200%
Intl - Global Medical Management	$29,526	210%
Plotkin Health	$29,526	210%
Sanus Health	$29,526	210%
Culinary Health Fund	$30,246	215%

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 Children's Hosp of Los Angeles 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.