CMS Price Transparency Data

Hip or knee replacement (inpatient stay)

Facility: North Vista Hospital

Billing Code: 470 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 470
Insurance Median: $22,363
Cash Discount Price: $17,316
vs. Medicare Baseline: 1.59x Medicare

The contracted insurance negotiated median rate for a Hip or knee replacement (inpatient stay) at North Vista Hospital is $22,363. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $17,316. Compared to the federal Medicare reimbursement reference rate of $14,044.15, this hospital’s rate is 1.59x the Medicare baseline. Located in 1409 East Lake Mead Blvd, North Las Vegas, NV.

Cash / Self-Pay

$17,316

Average discount available for prompt cash payment at this facility.

Insurance Median

$22,363

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%)

Cash / Self-Pay: $17,316 (123%)

Insurance Median: $22,363 (159%)

Cash: $17,316 (123% of Medicare)

Ins. Median: $22,363 (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
UnitedHealthcare	$3,773	27%
Triwest	$17,143	122%
Aetna	$17,316	123%
Blue Cross Blue Shield	$17,316	123%
Intermountain Healthcare (Hcp)	$17,316 - $25,974	123%
Medicare (plans)	$17,316	123%
Molina Healthcare	$17,316	123%
Renal Payor Solutions	$17,316	123%
Silver Summit	$17,316 - $25,628	123%
Tricare	$17,316 - $22,363	123%
Alignment	$17,662	126%
Employer Direct Healthcare	$22,511	160%
Health Services Coalition	$25,974	185%
Imperial Insurance Companies	$25,974 - $32,035	185%
Naphcare	$26,840	191%
National Healthcare Solutions, Inc	$27,706	197%
Nevada Health Partners	$28,383	202%
6 Degrees Health	$30,823	219%

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 $17,316.
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 North Vista 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.