CMS Price Transparency Data

Hip or knee replacement (inpatient stay)

Facility: Oviedo Medical Center

Billing Code: 470 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 470
Insurance Median: $17,789
Cash Discount Price: Unavailable
vs. Medicare Baseline: 1.27x Medicare

The contracted insurance negotiated median rate for a Hip or knee replacement (inpatient stay) at Oviedo Medical Center is $17,789. 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 1.27x the Medicare baseline. Located in 8300 Red Bug Lake Rd, Oviedo, FL.

Cash / Self-Pay

Unavailable

Average discount available for prompt cash payment at this facility.

Insurance Median

$17,789

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: $17,789 (127%)

Ins. Median: $17,789 (127% 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	$1,551 - $61,937	11%
Sunshine State Health Plan	$2,348 - $11,736	17%
Cigna	$2,834 - $51,371	20%
United	$4,222 - $43,981	30%
Humana	$7,247 - $57,973	52%
Wellmed	$16,447	117%
Blue Cross Blue Shield	$16,950 - $46,488	121%
Fl Health Care Plan	$16,950	121%
Devoted Health	$17,118	122%
Ultimate Health Plan	$17,118	122%
Aetna	$17,202 - $32,806	122%
Freedom Health	$17,454	124%
Optimum	$17,454	124%
Solis Health Plan	$17,454	124%
Sunshine State	$17,538	125%
Wellcare	$17,538	125%
Clear Spring Health	$17,621	125%
Longevity Health Plan	$17,621	125%
Simply	$17,621	125%
American Health Plan	$17,789	127%
Molina Healthcare	$17,789	127%
Careplus	$18,293 - $19,300	130%
Align Senior Care	$18,461	131%
Centurion	$18,461	131%
Florida Complete Care	$18,461	131%
Simply Healthcare	$18,820	134%
Gold Kidney Of Florida	$19,300	137%
Ndms Definitive Care	$20,978	149%
Oscar	$26,179	186%
Truli For Health	$28,690	204%
Florida Health Care Plan	$30,909	220%
Evolutions	$31,262	223%

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 Oviedo Medical Center 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.