CMS Price Transparency Data

Hip or knee replacement (inpatient stay)

Facility: HCA Florida Twin Cities Hospital

Billing Code: 470 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 470
Insurance Median: $15,333
Cash Discount Price: Unavailable
vs. Medicare Baseline: 1.09x Medicare

The contracted insurance negotiated median rate for a Hip or knee replacement (inpatient stay) at HCA Florida Twin Cities Hospital is $15,333. 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 1.09x the Medicare baseline. Located in 2190 Hwy 85 N, Niceville, FL.

Cash / Self-Pay

Unavailable

Average discount available for prompt cash payment at this facility.

Insurance Median

$15,333

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: $15,333 (109%)

Ins. Median: $15,333 (109% 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
Molina Healthcare	$2,201 - $15,333	16%
Sunshine State Health Plan	$2,348 - $11,736	17%
Cigna	$2,374 - $78,075	17%
Avmed	$2,968 - $48,897	21%
Humana	$6,935 - $55,477	49%
United	$7,876 - $49,006	56%
Wellmed	$14,176	101%
Regency Hospice	$14,465	103%
Blue Cross Blue Shield	$14,610 - $52,451	104%
Ultimate Health Plan	$14,754	105%
Aetna	$14,826 - $102,021	106%
Simply	$15,188	108%
American Health Plan	$15,333	109%
Healthspring Of Florida	$15,477	110%
Sunshine State	$15,550	111%
Wellcare	$15,550	111%
Centurion	$15,911	113%
Florida Complete Care	$16,201	115%
Longevity Health Plan	$16,201	115%
Gold Kidney Of Florida	$16,635	118%
Ndms Definitive Care	$18,081	129%
Simply Healthcare	$18,820	134%
Oscar	$21,932	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 $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 HCA Florida Twin Cities 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.