CMS Price Transparency Data

Hip or knee replacement (inpatient stay)

Facility: The McDowell Hospital

Billing Code: 470 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 470
Insurance Median: $17,606
Cash Discount Price: Unavailable
vs. Medicare Baseline: 1.25x Medicare

The contracted insurance negotiated median rate for a Hip or knee replacement (inpatient stay) at The McDowell Hospital is $17,606. 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 1.25x the Medicare baseline. Located in 430 Rankin Drive P O Box 730, Marion, NC.

Cash / Self-Pay

Unavailable

Average discount available for prompt cash payment at this facility.

Insurance Median

$17,606

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: $17,606 (125%)

Ins. Median: $17,606 (125% 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
United	$16,482 - $16,531	117%
Aetna	$16,862	120%
Alignment Health	$16,862	120%
Devoted Health	$16,862	120%
Humana	$17,027 - $17,193	121%
Wellcare	$17,027 - $23,978	121%
Cigna	$17,193	122%
Provider Partners Health Plan	$17,358	124%
Troy Healthcare	$17,358	124%
Apex Health	$17,523	125%
Longevity Health Plan	$17,688	126%
Nhc Advantage	$17,688	126%
Amerihealth Caritas	$18,846 - $32,855	134%
Healthteam Advantage	$19,838	141%
Blue Cross Blue Shield	$23,280	166%
Vaya Health	$23,978	171%
Amerihealth	$24,211	172%
Partners Health Management	$24,444	174%
Ambetter / Centene	$32,818	234%

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 The McDowell 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.