CMS Price Transparency Data

Hip or knee replacement (inpatient stay)

Facility: East Cooper Medical Center

Billing Code: 470 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 470
Insurance Median: $17,798
Cash Discount Price: $28,085
vs. Medicare Baseline: 1.27x Medicare

The contracted insurance negotiated median rate for a Hip or knee replacement (inpatient stay) at East Cooper Medical Center is $17,798. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $28,085. Compared to the federal Medicare reimbursement reference rate of $14,044.15, this hospital’s rate is 1.27x the Medicare baseline. Located in 2000 Hospital Dr, Mount Pleasant, SC.

Cash / Self-Pay

$28,085

Average discount available for prompt cash payment at this facility.

Insurance Median

$17,798

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: $28,085 (200%)

Insurance Median: $17,798 (127%)

Cash: $28,085 (200% of Medicare)

Ins. Median: $17,798 (127% 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
Absolute Total Care	$14,238 - $24,917	101%
Aetna	$14,238	101%
Devoted Health	$14,238	101%
Humana	$14,238	101%
UnitedHealthcare	$14,381 - $63,895	102%
Molina	$14,523 - $20,646	103%
Cigna	$14,666 - $33,247	104%
Clover Insurance Company	$14,808	105%
Select Health	$14,950 - $27,195	106%
Blue Cross Blue Shield	$21,659 - $38,823	154%
Medcost - Sc	$28,446	203%

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 $28,085.
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 East Cooper 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.