CMS Price Transparency Data

Hip or knee replacement (inpatient stay)

Facility: Prisma Health Baptist

Billing Code: 470 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 470
Insurance Median: $17,025
Cash Discount Price: $64,619
vs. Medicare Baseline: 1.21x Medicare

The contracted insurance negotiated median rate for a Hip or knee replacement (inpatient stay) at Prisma Health Baptist is $17,025. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $64,619. Compared to the federal Medicare reimbursement reference rate of $14,044.15, this hospital’s rate is 1.21x the Medicare baseline. Located in 1330 Taylor at Marion St, Columbia, SC.

Cash / Self-Pay

$64,619

Average discount available for prompt cash payment at this facility.

Insurance Median

$17,025

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: $64,619 (460%)

Insurance Median: $17,025 (121%)

Cash: $64,619 (460% of Medicare)

Ins. Median: $17,025 (121% 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	40%
UnitedHealthcare	$5,652 - $32,296	40%
Blue Cross Blue Shield	$16,214 - $57,670	115%
Cigna	$16,214 - $46,531	115%
Humana	$16,214	115%
Medicare (plans)	$16,214 - $17,025	115%
Ambetter / Centene	$16,253	116%
Covid19 Hrsa Uninsured Testing & Treatment Fund [904]	$16,253	116%
Triwest Healthcare Alliance Vcp [902]	$16,253	116%
Va Community Care Network-Vaccn [903]	$16,253	116%
Aetna	$17,025	121%
Healthy Conn Prime-First Choice Vip Care [5300]	$17,025	121%
Healthy Conn Prime-Molina Healthcare [5330]	$17,025	121%
Healthy Conn Prime-Wellcare Prime By Atc [5310]	$17,025	121%
Workers Comp [600]	$22,700	162%
Scdc-Sc Dept Of Corrections [7232]	$29,884	213%
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%
Promise Health Plan Contracted [2401]	$37,614	268%
Bluechoice [810]	$39,257 - $57,805	280%
Evernorth Behavioral Contracted [2982]	$46,531	331%
Planned Administrators [820]	$57,670	411%

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 $64,619.
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 Baptist 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.