CMS Price Transparency Data

Hip or knee replacement (inpatient stay)

Facility: HCA Florida Capital Hospital

Billing Code: 470 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 470
Insurance Median: $18,162
Cash Discount Price: Unavailable
vs. Medicare Baseline: 1.29x Medicare

The contracted insurance negotiated median rate for a Hip or knee replacement (inpatient stay) at HCA Florida Capital Hospital is $18,162. 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 1.29x the Medicare baseline. Located in 2626 Capital Medical Blvd, Tallahassee, FL.

Cash / Self-Pay

Unavailable

Average discount available for prompt cash payment at this facility.

Insurance Median

$18,162

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: $18,162 (129%)

Ins. Median: $18,162 (129% 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 - $18,034	16%
Sunshine State Health Plan	$2,336 - $11,680	17%
Cigna	$2,374 - $78,075	17%
Avmed	$2,968 - $48,897	21%
Humana	$4,741 - $45,503	34%
United	$5,314 - $41,982	38%
Wellmed	$16,673	119%
United Behavioral Health	$17,013	121%
Blue Cross Blue Shield	$17,183 - $42,278	122%
Ultimate Health Plan	$17,354	124%
Aetna	$17,439 - $28,413	124%
Simply	$17,864	127%
American Health Plan	$18,034	128%
Sunshine State	$18,289	130%
Wellcare	$18,289	130%
Align Senior Care	$18,715	133%
Centurion	$18,715	133%
Florida Complete Care	$18,715	133%
Longevity Health Plan	$18,715	133%
Simply Healthcare	$18,820	134%
Gold Kidney Of Florida	$19,565	139%
Gadsden County Jail	$21,267	151%
Ndms Definitive Care	$21,267	151%
Physician Network Association	$22,117	157%
Oscar	$24,021	171%
Naphcare	$27,221	194%

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 Capital 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.