CMS Price Transparency Data

Hip or knee replacement (inpatient stay)

Facility: HCA Florida North Florida Hospital

Billing Code: 470 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 470
Insurance Median: $18,832
Cash Discount Price: Unavailable
vs. Medicare Baseline: 1.34x Medicare

The contracted insurance negotiated median rate for a Hip or knee replacement (inpatient stay) at HCA Florida North Florida Hospital is $18,832. 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 1.34x the Medicare baseline. Located in 6500 W Newberry Rd, Gainesville, FL.

Cash / Self-Pay

Unavailable

Average discount available for prompt cash payment at this facility.

Insurance Median

$18,832

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: $18,832 (134%)

Ins. Median: $18,832 (134% 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	$1,498 - $51,831	11%
Molina Healthcare	$2,201 - $18,921	16%
Sunshine State Health Plan	$2,336 - $11,680	17%
Cigna	$2,374 - $78,075	17%
Humana	$4,954 - $47,551	35%
United	$6,086 - $41,821	43%
Simply Healthcare	$15,119	108%
Oscar	$15,979	114%
Hospice Of North Central Fl	$16,065	114%
Wellmed	$17,493	125%
United Behavioral Health	$17,850	127%
Va Purchased Care Program	$17,850	127%
Blue Cross Blue Shield	$18,029 - $41,467	128%
Capital Health Plan	$18,029 - $39,437	128%
Ultimate Health Plan	$18,207	130%
Aetna	$18,297 - $32,806	130%
Simply	$18,743	133%
American Health Plan	$18,921	135%
Sunshine State	$19,189	137%
Wellcare	$19,189	137%
Centurion	$19,635	140%
Longevity Health Plan	$19,992	142%
Gold Kidney Of Florida	$20,528	146%
Align Senior Care	$21,063	150%
Florida Complete Care	$21,063	150%
Ndms Definitive Care	$22,313	159%
Evolutions	$31,262	223%
Corizon Phs	$35,701	254%

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 North Florida 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.