CMS Price Transparency Data

Hip or knee replacement (inpatient stay)

Facility: Sunrise Hospital and Medical Center

Billing Code: 470 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 470
Insurance Median: $17,386
Cash Discount Price: Unavailable
vs. Medicare Baseline: 1.24x Medicare

The contracted insurance negotiated median rate for a Hip or knee replacement (inpatient stay) at Sunrise Hospital and Medical Center is $17,386. 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 1.24x the Medicare baseline. Located in 3186 S Maryland Pkwy, Las Vegas, NV.

Cash / Self-Pay

Unavailable

Average discount available for prompt cash payment at this facility.

Insurance Median

$17,386

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: $17,386 (124%)

Ins. Median: $17,386 (124% 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
Molina Healthcare	$1,550	11%
Estudysite	$2,000	14%
Sierra	$2,552 - $20,094	18%
Humana	$3,148 - $17,969	22%
Multiplan	$3,186	23%
First Health	$3,456	25%
Select Health	$3,588 - $47,537	26%
United	$3,592 - $27,611	26%
Hometown Health Providers	$3,784 - $28,799	27%
Health Services Coalition	$3,896 - $31,390	28%
Prominence Healthfirst	$4,095	29%
Aetna	$4,164 - $32,954	30%
Cigna	$4,347 - $57,423	31%
Blue Cross Blue Shield	$4,514 - $42,687	32%
Nevada Preferred Professionals	$11,304	80%
Hometown Health Mcr	$16,864 - $17,430	120%
Alignment Health Plan	$17,386 - $17,969	124%
Ambetter / Centene	$17,386 - $32,345	124%
Triwest Healthcare Alliance	$17,386 - $17,969	124%
Caremore	$17,733 - $18,329	126%
Imperial Nv	$18,255 - $18,868	130%
Universal Healthcare	$18,603 - $19,227	132%

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 Sunrise Hospital and 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.