CMS Price Transparency Data

Hip or knee replacement (inpatient stay)

Facility: Lexington Medical Center

Billing Code: 470 (MS-DRG)

The BaseRate · fair price high confidence

A fair price for this

$17,681

about 1.3× the $14,044 Medicare rate · typically $15,833–$26,123

modeled estimate · not a bill or quote

What this hospital charges insurers

$18,125

About the fair price

about $444 over the fair price · 1.3× Medicare

Medicare pays $14,044 Fair price $17,681 This hospital $18,125

How we calculate the fair BaseRate →

How this hospital compares to other SC hospitals

Highest price of the 9 SC hospitals we have prices for — worth calling around.

Cheapest $10,535 Priciest $18,125

Black dot = this hospital, among the 9 SC hospitals with a price for this procedure. Full list below.

A fair price for a Hip or knee replacement (inpatient stay) is about $17,681 (about 1.3× the $14,044 Medicare rate). Lexington Medical Center charges insurers about $18,125 — about the fair price. Located in West Columbia, SC.

What each insurance company pays

Which insurers have negotiated a price with this hospital for this procedure — and which haven’t.

5 of 6 major insurers have a published price at this hospital

✓ UnitedHealthcare✓ Blue Cross Blue Shield✓ Aetna✓ Cigna✓ Humana Kaiser Permanente

Crossed out = this hospital hasn’t published a negotiated price for that insurer for this procedure. It doesn’t necessarily mean they aren’t accepted — ask your insurer.

Insurance company	Price range	vs. Medicare
UnitedHealthcaremajor	$15,104 - $51,734	108%
Blue Cross Blue Shieldmajor	$15,104 - $62,245	108%
Aetnamajor	$16,161	115%
Cignamajor	$58,271	415%
Humanamajor	$16,010	114%
Ambetter (Centene)	$36,249	258%
Molina	$18,125 - $35,796	129%
WellCare	$16,161	115%
+ 3 smaller / regional plans	$15,859 - $72,787

Excludes 1 rental-network / third-party entry (e.g. Multiplan, PHCS) — these are pricing networks, not insurers.

Self-Pay How to get the cash price

Tell the billing desk you want to be billed as self-pay — not through insurance — before your visit.
Ask for the cash / prompt-pay discount in writing, with the exact price, before you agree to anything.
Get it in writing that they won’t also bill your insurance, so the cash price is what you owe.
Check the MS-DRG code on your bill matches exactly: 470.

Insurance Before you use insurance

Call your insurance company to confirm Lexington Medical Center is in-network.
Ask your insurer whether prior approval is required for MS-DRG code 470.
Confirm the doctor or provider is in-network too — not just the hospital building.
Check your Explanation of Benefits against the hospital’s final itemized bill.

Estimate your out-of-pocket cost

A rough estimate of what you’d pay with insurance (deductible + coinsurance) versus paying the cash price yourself.

How you’d pay

Deductible left to meet ($)

Your coinsurance (%)

Enter your details and press estimate to compare.

Other Procedures at Lexington Medical Center

Compare: Hip or knee replacement (inpatient stay) at other SC hospitals

Prisma Health Tuomey Hospital · Sumter $10,535
Anmed Health · Anderson $11,193
Cannon Memorial Hospital · Pickens $11,420
McLeod Loris Hospital · Loris $13,303
MUSC Health Black River Medical Center · Cades $13,529
Aiken Regional Medical Center · Aiken $13,642
Cherokee Medical Center · Gaffney $13,809
Prisma Health Patewood Hospital · Greenville $14,493

Insurance negotiated median for the same procedure, sorted lowest first.