CMS Price Transparency Data

Hip or knee replacement (inpatient stay)

Facility: Crystal Clinic Orthopaedic Center

Billing Code: 470 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 470
Insurance Median: $28,192
Cash Discount Price: $216,266
vs. Medicare Baseline: 2.01x Medicare

The contracted insurance negotiated median rate for a Hip or knee replacement (inpatient stay) at Crystal Clinic Orthopaedic Center is $28,192. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $216,266. Compared to the federal Medicare reimbursement reference rate of $14,044.15, this hospital’s rate is 2.01x the Medicare baseline. Located in 444 North Main Street, Akron, OH.

Cash / Self-Pay

$216,266

Average discount available for prompt cash payment at this facility.

Insurance Median

$28,192

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: $216,266 (1540%)

Insurance Median: $28,192 (201%)

Cash: $216,266 (1540% of Medicare)

Ins. Median: $28,192 (201% 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 201% of the Medicare baseline (a markup of 101%). 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
Bc Mcr Adv	$12,979	92%
Summacare Mcr Adv	$12,979	92%
UnitedHealthcare	$12,979 - $26,862	92%
Bc Pathway	$15,302	109%
Bc Ohi/Ohii	$23,209	165%
Med Mutual Aca	$25,346	180%
Bc Blue Access	$25,796	184%
Bc Preferred	$25,796	184%
Bc Trad - All Other Plans	$25,796	184%
The Health Plan - All Plans	$25,958	185%
Summacare Comm - All Other Plans	$29,523	210%
Med Mutual Medflex	$30,118	214%
Aultcare - All Plans	$30,277	216%
Cigna	$30,425	217%
Aetna	$35,170	250%
Health Oh Network - All Plans	$37,074	264%
Ohio Health Choice - All Plans	$37,074	264%
Med Mutual Ppo/Pos/Hmo - All Other Plans	$37,764	269%
Med Mutual Nas	$38,557	275%
Multiplan - All Plans	$40,782	290%
Healthsmart - All Plans	$52,522	374%

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 $216,266.
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 Crystal Clinic Orthopaedic 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.