CMS Price Transparency Data

Hip or knee replacement (inpatient stay)

Facility: Cincinnati Children's Hospital Medical Center

Billing Code: 470 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 470
Insurance Median: $8,848
Cash Discount Price: $37,714
vs. Medicare Baseline: 0.63x Medicare

The contracted insurance negotiated median rate for a Hip or knee replacement (inpatient stay) at Cincinnati Children's Hospital Medical Center is $8,848. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $37,714. Compared to the federal Medicare reimbursement reference rate of $14,044.15, this hospital’s rate is 0.63x the Medicare baseline. Located in 3333 Burnet Avenue, Cincinnati, OH.

Cash / Self-Pay

$37,714

Average discount available for prompt cash payment at this facility.

Insurance Median

$8,848

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: $37,714 (269%)

Insurance Median: $8,848 (63%)

Cash: $37,714 (269% of Medicare)

Ins. Median: $8,848 (63% 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
Amerihealth_Caritas_Oh	$7,962	57%
Blue Cross Blue Shield	$7,962 - $8,848	57%
Buckeye_Oh	$7,962	57%
Caresource_Oh	$7,962	57%
Humana	$7,962 - $12,627	57%
Molina_Oh	$7,962	57%
United_Health_Care_Oh	$7,962	57%
Caresource_In	$8,848	63%
Mhs_In	$8,848	63%
Aetna	$12,627	90%
Passport_Ky	$12,627	90%
United_Health_Care_Ky	$12,627	90%
Wellcare_Ky	$12,627	90%

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 $37,714.
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 Cincinnati Children's Hospital 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.