CMS Price Transparency Data

Hip or knee replacement (inpatient stay)

Facility: Ascension St Vincent Carmel

Billing Code: 470 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 470
Insurance Median: $14,575
Cash Discount Price: Unavailable
vs. Medicare Baseline: 1.04x Medicare

The contracted insurance negotiated median rate for a Hip or knee replacement (inpatient stay) at Ascension St Vincent Carmel is $14,575. 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 1.04x the Medicare baseline. Located in 13500 N Meridian St, Carmel, IN.

Cash / Self-Pay

Unavailable

Average discount available for prompt cash payment at this facility.

Insurance Median

$14,575

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: $14,575 (104%)

Ins. Median: $14,575 (104% 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
Prohealth	$7,940	57%
Suburban Tpa	$7,940	57%
Suburban/Sho	$7,940	57%
Aetna	$11,231	80%
Advantage 360	$11,500 - $12,200	82%
One Health Plan	$11,500	82%
Blue Cross Blue Shield	$11,641 - $24,983	83%
Encore	$13,400	95%
Encore Exclusive	$13,400	95%
Humana	$13,469 - $16,535	96%
Cigna	$13,479 - $19,607	96%
Smarthealth Ppo/Hdhp 20161001	$13,700	98%
Unified Zionsville	$13,965 - $14,963	99%
Siho Ppo	$15,000	107%
UnitedHealthcare	$17,634 - $19,069	126%
Unified Group Services	$18,572 - $19,901	132%
Sagamore Plus Drg	$19,607	140%

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 Ascension St Vincent Carmel 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.