Hip or knee replacement (inpatient stay)
Facility: Mid-Columbia Medical Center
Billing Code: 470 (MS-DRG)
- CPT Billing Code: 470
- Insurance Median: $32,811
- Cash Discount Price: $22,876
- vs. Medicare Baseline: 2.34x Medicare
Average discount available for prompt cash payment at this facility.
Median negotiated contract rate across all mapped commercial carriers.
Standard federal government reimbursement rate for this code.
Visual Cost Comparison vs. 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 234% of the Medicare baseline (a markup of 134%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.
Out-of-Pocket Cost Estimator
Estimate whether it is more economical to use your insurance or pay the upfront self-pay cash rate.
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 | $3,440 | 24% |
| First Health - All Plans | $4,400 | 31% |
| Blue Cross Blue Shield | $16,043 - $41,177 | 114% |
| Community Hp Mcr Adv - All Plans | $16,043 | 114% |
| Moda Mcr Adv | $16,043 | 114% |
| Molina Mcr Adv | $16,043 | 114% |
| Tricare | $16,043 | 114% |
| Va Ccn Triwest - All Plans | $16,043 | 114% |
| Healthnet Mcr Adv | $16,364 | 117% |
| Humana | $16,845 | 120% |
| Wellcare Mcr Adv - All Plans | $16,845 | 120% |
| Devoted Mcr Adv - All Plans | $17,326 | 123% |
| Molina - All Other Plans | $17,647 | 126% |
| Norocor - All Plans | $23,829 | 170% |
| Employee Health Plan - All Plans | $28,877 | 206% |
| Moda Health Plan - All Other Plans | $32,694 | 233% |
| Amerigroup Mcaid - All Plans | $34,314 | 244% |
| Coordinated Care Mcaid - All Plans | $34,314 | 244% |
| Molina Mcaid | $34,314 | 244% |
| UnitedHealthcare | $34,314 - $42,893 | 244% |
| Healthscape - All Plans | $38,127 | 271% |
| Cigna | $42,559 | 303% |
| Healthnet - All Other Plans | $42,893 | 305% |
| Pacific Source - All Plans | $43,846 | 312% |
| First Choice - All Plans | $44,323 | 316% |
| Ahp - Americas Hlth Plan - All Plans | $45,276 | 322% |
| Coventry - All Plans | $45,276 | 322% |
| Multiplan/Phcs - All Plans | $45,276 | 322% |
| Providence Ppo - All Plans | $45,276 | 322% |
| Trpn - Three Rivers - All Plans | $45,276 | 322% |