CMS Price Transparency Data

Hip or knee replacement (inpatient stay)

Facility: Claiborne Memorial Medical Center

Billing Code: 470 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 470
Insurance Median: $12,535
Cash Discount Price: Unavailable
vs. Medicare Baseline: 0.89x Medicare

The contracted insurance negotiated median rate for a Hip or knee replacement (inpatient stay) at Claiborne Memorial Medical Center is $12,535. 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 0.89x the Medicare baseline. Located in 620 East College Street, Homer, LA.

Cash / Self-Pay

Unavailable

Average discount available for prompt cash payment at this facility.

Insurance Median

$12,535

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: $12,535 (89%)

Ins. Median: $12,535 (89% 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
Aetna	$12,535	89%
Arcadian Community Mcr Hm	$12,535	89%
Blue Cross Blue Shield	$12,535 - $15,289	89%
Champus	$12,535	89%
Champva	$12,535	89%
Cigna	$12,535	89%
Healthy Blue Dual Adv	$12,535	89%
Humana	$12,535	89%
Kaiser Foundation Health	$12,535	89%
Medicare (plans)	$12,535 - $13,743	89%
Peoples Health Network	$12,535	89%
Pyramid Claims Mcr Hmo	$12,535	89%
Sterling Connect 2	$12,535	89%
Sterling Premier Mc Hmo	$12,535	89%
Superior Health Mcr Hmo	$12,535	89%
Tenet Mcr Hmo	$12,535	89%
Tricare	$12,535 - $13,863	89%
United Hc Mcr Hmo	$12,535	89%
UnitedHealthcare	$12,535 - $16,185	89%
Universal Hc Mcr Hmo	$12,535	89%
Us Dept Of Labor	$12,535	89%
Vantage Health Mcr Hmo	$12,535 - $13,743	89%
Windsor Sterling Mcr Hmo	$12,535	89%
Wps Mvh Vapc3	$12,535	89%
All Savers	$16,185	115%
Golden Rule Ins Co	$16,185	115%
United Behavioral Health	$16,185	115%

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 Claiborne Memorial 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.