CMS Price Transparency Data

Hip or knee replacement (inpatient stay)

Facility: Prisma Health Richland Hospital

Billing Code: 470 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 470
Insurance Median: $18,338
Cash Discount Price: $67,717
vs. Medicare Baseline: 1.31x Medicare

The contracted insurance negotiated median rate for a Hip or knee replacement (inpatient stay) at Prisma Health Richland Hospital is $18,338. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $67,717. Compared to the federal Medicare reimbursement reference rate of $14,044.15, this hospital’s rate is 1.31x the Medicare baseline. Located in 5 Medical Park, Columbia, SC.

Cash / Self-Pay

$67,717

Average discount available for prompt cash payment at this facility.

Insurance Median

$18,338

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: $67,717 (482%)

Insurance Median: $18,338 (131%)

Cash: $67,717 (482% of Medicare)

Ins. Median: $18,338 (131% 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
Medicaid / KanCare	$5,652 - $10,126	40%
UnitedHealthcare	$5,652 - $32,296	40%
Humana	$8,341 - $16,477	59%
Blue Cross Blue Shield	$16,477 - $57,643	117%
Cigna	$16,477 - $46,531	117%
Medicare (plans)	$16,477 - $18,338	117%
Aetna	$17,301	123%
Healthy Conn Prime-First Choice Vip Care [5300]	$17,301	123%
Healthy Conn Prime-Molina Healthcare [5330]	$17,301	123%
Healthy Conn Prime-Wellcare Prime By Atc [5310]	$17,301	123%
Ambetter / Centene	$18,338	131%
Covid19 Hrsa Uninsured Testing & Treatment Fund [904]	$18,338	131%
Triwest Healthcare Alliance Vcp [902]	$18,338	131%
Va Community Care Network-Vaccn [903]	$18,338	131%
Workers Comp [600]	$23,067	164%
Bob Jones Univ-Pai [821]	$30,920	220%
Golden Rule Insurance Company [2991]	$32,296	230%
Oxford Health Plans [2992]	$32,296	230%
Zzumr-Salt Lake City Ut [3169]	$32,296	230%
Preferred Administrators Contracted [2839]	$34,253	244%
Sc Dept Of Corrections [2998]	$35,198	251%
Scdc-Sc Dept Of Corrections [7232]	$35,198	251%
Promise Health Plan Contracted [2401]	$37,614	268%
Bluechoice [810]	$38,694 - $52,538	276%
Evernorth Behavioral Contracted [2982]	$46,531	331%
Planned Administrators [820]	$57,643	410%

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 $67,717.
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 Prisma Health Richland 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.