CMS Price Transparency Data

Hip or knee replacement (inpatient stay)

Facility: Kettering Health Troy

Billing Code: 470 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 470
Insurance Median: $23,837
Cash Discount Price: Unavailable
vs. Medicare Baseline: 1.70x Medicare

The contracted insurance negotiated median rate for a Hip or knee replacement (inpatient stay) at Kettering Health Troy is $23,837. 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 1.70x the Medicare baseline. Located in 600 West Main Street, Troy, OH.

Cash / Self-Pay

Unavailable

Average discount available for prompt cash payment at this facility.

Insurance Median

$23,837

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: $23,837 (170%)

Ins. Median: $23,837 (170% 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	$15,210 - $32,854	108%
Blue Cross Blue Shield	$15,210 - $34,925	108%
Buckeye Health Plan	$15,210 - $25,856	108%
Caresource	$15,210 - $23,506	108%
Cigna	$15,210 - $38,234	108%
Devoted Health	$15,210	108%
Humana	$15,210	108%
Medical Mutual	$15,210 - $39,298	108%
Medigold	$15,210	108%
UnitedHealthcare	$15,210 - $39,673	108%
Valor Health Plan	$15,210	108%
Molina Healthcare	$15,970 - $31,245	114%
Custom Design Benefits Inc.	$35,741	254%

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 Kettering Health Troy 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.