CMS Price Transparency Data

Hip or knee replacement (inpatient stay)

Facility: T J Samson Community Hospital

Billing Code: 470 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 470
Insurance Median: $8,915
Cash Discount Price: $5,795
vs. Medicare Baseline: 0.63x Medicare

The contracted insurance negotiated median rate for a Hip or knee replacement (inpatient stay) at T J Samson Community Hospital is $8,915. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $5,795. Compared to the federal Medicare reimbursement reference rate of $14,044.15, this hospital’s rate is 0.63x the Medicare baseline. Located in 1301 North Race Street, Glasgow, KY.

Cash / Self-Pay

$5,795

Average discount available for prompt cash payment at this facility.

Insurance Median

$8,915

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%)

Cash / Self-Pay: $5,795 (41%)

Insurance Median: $8,915 (63%)

Cash: $5,795 (41% of Medicare)

Ins. Median: $8,915 (63% 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
Blue Cross Blue Shield	$3,452 - $14,404	25%
Center Care Select - All Plans	$7,578	54%
Phcs/Multiplan - All Plans	$8,380	60%
First Health - All Plans	$8,469	60%
Caresource - All Plans	$8,915	63%
Devoted Mcr Adv - All Plans	$8,915	63%
Humana	$8,915 - $14,404	63%
Molina Marketplace - All Other Plans	$8,915	63%
Molina Mcaid	$8,915	63%
Molina Mcr Adv	$8,915	63%
UnitedHealthcare	$8,915	63%
Wellcare Mcaid	$8,915	63%
Wellcare Mcr Adv - All Other Plans	$8,915	63%
Aetna	$12,684	90%
Signature Health - All Plans	$14,548	104%

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 $5,795.
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 T J Samson Community 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.