CMS Price Transparency Data

Hip or knee replacement (inpatient stay)

Facility: Ohio State University State Health System

Billing Code: 470 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 470
Insurance Median: $34,103
Cash Discount Price: Unavailable
vs. Medicare Baseline: 2.43x Medicare

The contracted insurance negotiated median rate for a Hip or knee replacement (inpatient stay) at Ohio State University State Health System is $34,103. 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 2.43x the Medicare baseline. Located in 410 West 10Th Avenue, Columbus, OH.

Cash / Self-Pay

Unavailable

Average discount available for prompt cash payment at this facility.

Insurance Median

$34,103

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: $34,103 (243%)

Ins. Median: $34,103 (243% 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.

Elevated Commercial Rate Alert (Value-Gap)

The negotiated rate at this facility is 243% of the Medicare baseline (a markup of 143%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.

Consult Patient Advocate

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
Blue Cross Blue Shield	$11,711 - $112,325	83%
Healthspan	$11,711 - $57,596	83%
Medigold	$11,711	83%
Ohio Dept Of Health	$11,711	83%
Upper Ohio Valley	$11,711 - $79,195	83%
Aetna	$11,882 - $96,474	85%
Medicare (plans)	$11,882 - $12,648	85%
Mmo	$11,882 - $35,039	85%
Humana	$11,945 - $30,705	85%
Caresource	$12,476 - $18,418	89%
Molina	$12,476 - $19,844	89%
Buckeye Community	$17,799 - $26,785	127%
Cigna	$28,164	201%
UnitedHealthcare	$30,921	220%
United	$37,504	267%
Osu Health Plan	$49,581 - $59,996	353%
Ohio Ppo	$57,464	409%
Ohiohealth	$77,995 - $87,595	555%
Lifetrac	$81,595	581%
Frontpath	$95,994	684%
Multiplan	$95,994	684%
Healthsmart	$107,993	769%

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 Ohio State University State Health System 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.