CMS Price Transparency Data

Hip or knee replacement (inpatient stay)

Facility: Atrium Health Cleveland

Billing Code: 470 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 470
Insurance Median: $22,334
Cash Discount Price: Unavailable
vs. Medicare Baseline: 1.59x Medicare

The contracted insurance negotiated median rate for a Hip or knee replacement (inpatient stay) at Atrium Health Cleveland is $22,334. 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 1.59x the Medicare baseline. Located in 201 E Grover St, Shelby, NC.

Cash / Self-Pay

Unavailable

Average discount available for prompt cash payment at this facility.

Insurance Median

$22,334

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: $22,334 (159%)

Ins. Median: $22,334 (159% 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
Humana	$14,822	106%
Aetna	$15,040	107%
Cigna	$15,258 - $36,422	109%
UnitedHealthcare	$15,303 - $21,052	109%
Amerihealth Caritas	$18,862	134%
Carolina Complete Health	$22,334	159%
Healthy Blue	$22,334	159%
Partners	$22,334	159%
Wellcare	$22,334	159%
Ambetter / Centene	$22,511 - $25,511	160%
Vaya	$22,557	161%
Alliance	$22,781	162%
Trillium	$23,004	164%
Blue Cross Blue Shield	$26,022 - $33,109	185%

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 Atrium Health Cleveland 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.