CMS Price Transparency Data

Hip or knee replacement (inpatient stay)

Facility: HCA Florida Memorial Hospital

Billing Code: 470 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 470
Insurance Median: $17,109
Cash Discount Price: Unavailable
vs. Medicare Baseline: 1.22x Medicare

The contracted insurance negotiated median rate for a Hip or knee replacement (inpatient stay) at HCA Florida Memorial Hospital is $17,109. 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 1.22x the Medicare baseline. Located in 3625 University Blvd S, Jacksonville, FL.

Cash / Self-Pay

Unavailable

Average discount available for prompt cash payment at this facility.

Insurance Median

$17,109

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: $17,109 (122%)

Ins. Median: $17,109 (122% 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
Avmed	$1,440 - $61,316	10%
Molina Healthcare	$1,834 - $11,098	13%
Cigna	$2,109 - $52,918	15%
Sunshine State Health Plan	$2,348 - $11,736	17%
Humana	$4,406 - $47,702	31%
United	$5,749 - $48,461	41%
Simply Healthcare	$14,964 - $17,787	107%
Hospice Community	$15,246	109%
Careplus	$16,940 - $19,481	121%
United Behavioral Health	$16,940	121%
Veterans Evaluation Services	$16,940	121%
Vitas Hospice	$16,940	121%
Wellcare	$17,025	121%
Wellmed	$17,025	121%
Aetna	$17,109 - $30,924	122%
Blue Cross Blue Shield	$17,109 - $52,591	122%
Sunshine State	$17,109	122%
Devoted Health	$17,279	123%
Optimum Healthcare	$17,618	125%
American Health Plan	$17,956	128%
Florida Complete Care	$18,295	130%
Positive Healthcare	$18,464	131%
Longevity	$18,634	133%
Oscar	$18,874	134%
Gold Kidney	$19,481	139%
Ndms Definitive Care	$21,175	151%
Corizon	$22,022	157%
Centurion	$23,885	170%

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 Memorial 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.