CMS Price Transparency Data

Hip or knee replacement (inpatient stay)

Facility: St Claire Regional Medical Center

Billing Code: 470 (MS-DRG)

The BaseRate · fair price high confidence

A fair price for this

$15,327

about 1.1× the $14,044 Medicare rate · typically $13,121–$25,279

modeled estimate · not a bill or quote

What this hospital charges insurers

$15,734

About the fair price

about $407 over the fair price · 1.1× Medicare

Medicare pays $14,044 Fair price $15,327 This hospital $15,734 Cash price $38,788 Hospital's list price $51,718

How we calculate the fair BaseRate →

How this hospital compares to other KY hospitals

Highest price of the 9 KY hospitals we have prices for — worth calling around.

Cheapest $8,915 Priciest $15,734

Black dot = this hospital, among the 9 KY hospitals with a price for this procedure. Full list below.

A fair price for a Hip or knee replacement (inpatient stay) is about $15,327 (about 1.1× the $14,044 Medicare rate). St Claire Regional Medical Center charges insurers about $15,734, or about $38,788 in cash — about the fair price. Located in Morehead, KY.

What each insurance company pays

Which insurers have negotiated a price with this hospital for this procedure — and which haven’t.

3 of 6 major insurers have a published price at this hospital

✓ Blue Cross Blue Shield✓ Aetna✓ Humana UnitedHealthcareCignaKaiser Permanente

Crossed out = this hospital hasn’t published a negotiated price for that insurer for this procedure. It doesn’t necessarily mean they aren’t accepted — ask your insurer.

Insurance company	Price range	vs. Medicare
Blue Cross Blue Shieldmajor	$14,551 - $35,851	104%
Aetnamajor	$11,115	79%
Humanamajor	$14,551 - $36,202	104%
CareSource	$14,551 - $18,917	104%
HealthLink	$14,718	105%
WellCare	$12,082 - $43,960	86%
+ 1 smaller / regional plan	$18,917

Government programs also on file: Medicaid.

Self-Pay How to get the cash price

Tell the billing desk you want to be billed as self-pay — not through insurance — before your visit.
Ask for the cash / prompt-pay discount in writing, with the exact price (about 38,788), before you agree to anything.
Get it in writing that they won’t also bill your insurance, so the cash price is what you owe.
Check the MS-DRG code on your bill matches exactly: 470.

Insurance Before you use insurance

Call your insurance company to confirm St Claire Regional Medical Center is in-network.
Ask your insurer whether prior approval is required for MS-DRG code 470.
Confirm the doctor or provider is in-network too — not just the hospital building.
Check your Explanation of Benefits against the hospital’s final itemized bill.

Estimate your out-of-pocket cost

A rough estimate of what you’d pay with insurance (deductible + coinsurance) versus paying the cash price yourself.

How you’d pay

Deductible left to meet ($)

Your coinsurance (%)

Enter your details and press estimate to compare.

Other Procedures at St Claire Regional Medical Center

Compare: Hip or knee replacement (inpatient stay) at other KY hospitals

T J Samson Community Hospital · Glasgow $8,915
Murray-Calloway County Hospital · Murray $12,980
Georgetown Community Hospital · Georgetown $13,126
Bourbon Community Hospital · Paris $13,289
Saint Joseph London · London $13,485
Clark Regional Medical Center · Winchester $13,488
Tristar Greenview Regional Hospital · Bowling Green $13,578
Jackson Purchase Medical Center · Mayfield $13,925

Insurance negotiated median for the same procedure, sorted lowest first.