CMS Price Transparency Data

Hip or knee replacement (inpatient stay)

Facility: Coshocton Regional Medical Center

Billing Code: 470 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 470
Insurance Median: $17,020
Cash Discount Price: $14,054
vs. Medicare Baseline: 1.21x Medicare

The contracted insurance negotiated median rate for a Hip or knee replacement (inpatient stay) at Coshocton Regional Medical Center is $17,020. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $14,054. Compared to the federal Medicare reimbursement reference rate of $14,044.15, this hospital’s rate is 1.21x the Medicare baseline. Located in 1460 Orange Street, Coshocton, OH.

Cash / Self-Pay

$14,054

Average discount available for prompt cash payment at this facility.

Insurance Median

$17,020

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: $14,054 (100%)

Insurance Median: $17,020 (121%)

Cash: $14,054 (100% of Medicare)

Ins. Median: $17,020 (121% 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
Blue Cross Blue Shield	$14,055	100%
Care Source	$14,055 - $20,379	100%
Medicare (plans)	$14,055	100%
Molina	$14,055 - $20,379	100%
The Health Plan	$14,055	100%
UnitedHealthcare	$14,055	100%
Med Mutual Of Oh	$14,336	102%
Buckeye Community Health Plan	$14,757 - $17,568	105%
Devoted Health	$14,757	105%
Valor Health Plan	$15,038	107%
Perennial Advantage	$15,460	110%
Americas Choice Provider Network	$17,020	121%
Corvel	$17,020	121%
Healthsmart	$17,020	121%
Multiplan	$17,020	121%
Provider Network Of America	$17,020	121%
Provider Select	$17,020	121%
Three Rivers	$17,020	121%
Workers Compensation	$17,020	121%
Employer Direct Healthcare	$18,271	130%
Tricare	$18,510	132%
National Healthcare Solutions, Inc.	$22,487	160%
Quality Care Partner	$26,001 - $28,812	185%

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 $14,054.
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 Coshocton Regional 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.