CMS Price Transparency Data

Hip or knee replacement (inpatient stay)

Facility: West Chester Hospital

Billing Code: 470 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 470
Insurance Median: $19,867
Cash Discount Price: Unavailable
vs. Medicare Baseline: 1.41x Medicare

The contracted insurance negotiated median rate for a Hip or knee replacement (inpatient stay) at West Chester Hospital is $19,867. 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 1.41x the Medicare baseline. Located in 7700 University Drive, West Chester, OH.

Cash / Self-Pay

Unavailable

Average discount available for prompt cash payment at this facility.

Insurance Median

$19,867

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: $19,867 (141%)

Ins. Median: $19,867 (141% 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	$14,191 - $26,976	101%
Blue Cross Blue Shield	$14,191 - $42,156	101%
Devoted Health	$14,191	101%
Humana	$14,191	101%
Medical Mutual	$14,191	101%
Molina Healthcare	$14,191 - $19,867	101%
Paramount	$14,191	101%
UnitedHealthcare	$14,191 - $27,631	101%
Usa Mco	$14,191	101%
Caresource	$14,333 - $18,448	102%
Perennial Advantage	$14,475	103%
Buckeye Health Plan	$14,901 - $19,867	106%
Communicare Advantage	$15,610	111%
Oscar	$21,218	151%
Cincinnati Public Library	$26,821	191%
Cronin Automotive	$26,821	191%
Great Parks Of Hamilton County	$26,821	191%
Green Township	$26,821	191%
Health Ohio Network	$26,821	191%
Madtree Brewing	$26,821	191%
Magellan Health	$26,821	191%
Ohio Valley Goodwill	$26,821	191%
Skilled Care Pharmacy	$26,821	191%
Springfield Township	$26,821	191%
Stock Material Handling Systems	$26,821	191%
Watson Gravel	$26,821	191%

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 West Chester 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.