CMS Price Transparency Data

Hip or knee replacement (inpatient stay)

Facility: HCA Florida Orange Park Hospital

Billing Code: 470 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 470
Insurance Median: $19,864
Cash Discount Price: Unavailable
vs. Medicare Baseline: 1.41x Medicare

The contracted insurance negotiated median rate for a Hip or knee replacement (inpatient stay) at HCA Florida Orange Park Hospital is $19,864. 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 1.41x the Medicare baseline. Located in 2001 Kingsley Ave, Orange Park, FL.

Cash / Self-Pay

Unavailable

Average discount available for prompt cash payment at this facility.

Insurance Median

$19,864

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: $19,864 (141%)

Ins. Median: $19,864 (141% 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%
United	$5,749 - $48,461	41%
Humana	$7,707 - $47,702	55%
Simply Healthcare	$14,964 - $20,650	107%
Hospice Community	$17,700	126%
Oscar	$18,874	134%
Careplus	$19,667 - $22,617	140%
United Behavioral Health	$19,667	140%
Veterans Evaluation Services	$19,667	140%
Wellmed	$19,765	141%
Blue Cross Blue Shield	$19,864 - $52,591	141%
Sunshine State	$19,864	141%
Wellcare	$19,864	141%
Devoted Health	$20,060	143%
Optimum Healthcare	$20,454	146%
Florida Complete Care	$20,650	147%
American Health Plan	$20,847	148%
Medicare (plans)	$21,240	151%
Positive Healthcare	$21,437	153%
Longevity	$21,634	154%
Gold Kidney	$22,617	161%
Clay County Sheriffs Office	$24,584	175%
Ndms Definitive Care	$24,584	175%
Aetna	$25,338 - $30,924	180%

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 Orange Park 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.