CMS Price Transparency Data

Hip or knee replacement (inpatient stay)

Facility: HCA Florida Raulerson Hospital

Billing Code: 470 (MS-DRG)

Factual Cost Summary (Answer Capsule)
  • CPT Billing Code: 470
  • Insurance Median: $15,091
  • Cash Discount Price: Unavailable
  • vs. Medicare Baseline: 1.07x Medicare
The contracted insurance negotiated median rate for a Hip or knee replacement (inpatient stay) at HCA Florida Raulerson Hospital is $15,091. 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 1.07x the Medicare baseline. Located in 1796 Hwy 441 North, Okeechobee, FL.
Cash / Self-Pay
Unavailable

Average discount available for prompt cash payment at this facility.

Insurance Median
$15,091

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: $15,091 (107%)
Ins. Median: $15,091 (107% 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.

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 $1,715 - $57,216 12%
Molina $1,834 - $15,234 13%
Sunshine State Health Plan $2,331 - $11,652 17%
Cigna $4,535 - $33,854 32%
Humana $4,630 - $57,406 33%
United $6,000 - $49,680 43%
Wellmed $13,941 99%
Veterans Evaluation Services $14,372 102%
Blue Cross Blue Shield $14,516 - $55,570 103%
Devoted Health $14,659 104%
Ultimate Health Plan $14,659 104%
Aetna $14,731 - $62,401 105%
Freedom Health $14,947 106%
Health Sun Health Plan $14,947 106%
Optimum $14,947 106%
Careplus $15,091 - $16,528 107%
Simply Healthcare Plans $15,091 107%
American Health Plan $15,234 108%
Sunshine State $15,378 - $15,809 109%
Centurion $15,809 113%
Florida Complete Care $15,809 113%
Longevity Health Plan $15,809 113%
Solis Health Plan $16,384 117%
Ndms Definitive Care $17,965 128%
Oscar $25,313 180%
Simply Healthcare $27,304 194%

Self-Pay Upfront Cash Action Plan

Insurance In-Network Protection Plan

Facility Profile & Credentials

  • Address: 1796 Hwy 441 North, Okeechobee, FL 34972
  • CMS Rating: ★★★☆☆
  • Ownership Type: Proprietary
  • Hospital Type: Acute Care Hospitals