CMS Price Transparency Data

Hip or knee replacement (inpatient stay)

Facility: University of Cincinnati Medical Center, LLC

Billing Code: 470 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 470
Insurance Median: $27,829
Cash Discount Price: Unavailable
vs. Medicare Baseline: 1.98x Medicare

The contracted insurance negotiated median rate for a Hip or knee replacement (inpatient stay) at University of Cincinnati Medical Center, LLC is $27,829. 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 1.98x the Medicare baseline. Located in 3188 Bellevue Avenue, Cincinnati, OH.

Cash / Self-Pay

Unavailable

Average discount available for prompt cash payment at this facility.

Insurance Median

$27,829

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: $27,829 (198%)

Ins. Median: $27,829 (198% 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	$20,614 - $34,726	147%
Blue Cross Blue Shield	$20,614 - $47,304	147%
Buckeye Health Plan	$20,614 - $28,860	147%
Devoted Health	$20,614	147%
Humana	$20,614 - $27,829	147%
Medical Mutual	$20,614	147%
Molina Healthcare	$20,614 - $28,860	147%
Paramount	$20,614	147%
UnitedHealthcare	$20,614 - $35,363	147%
Usa Mco	$20,614	147%
Caresource	$20,820 - $26,798	148%
Perennial Advantage	$21,026	150%
Oscar	$22,568	161%
Communicare Advantage	$22,675	161%
Cincinnati Public Library	$38,960	277%
Cronin Automotive	$38,960	277%
Great Parks Of Hamilton County	$38,960	277%
Green Township	$38,960	277%
Health Ohio Network	$38,960	277%
Madtree Brewing	$38,960	277%
Magellan Health	$38,960	277%
Ohio Valley Goodwill	$38,960	277%
Skilled Care Pharmacy	$38,960	277%
Springfield Township	$38,960	277%
Stock Material Handling Systems	$38,960	277%
Watson Gravel	$38,960	277%

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 University of Cincinnati Medical Center, LLC 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.