CMS Price Transparency Data

Hip or knee replacement (inpatient stay)

Facility: Blount Memorial Hospital

Billing Code: 470 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 470
Insurance Median: $12,880
Cash Discount Price: $30,753
vs. Medicare Baseline: 0.92x Medicare

The contracted insurance negotiated median rate for a Hip or knee replacement (inpatient stay) at Blount Memorial Hospital is $12,880. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $30,753. Compared to the federal Medicare reimbursement reference rate of $14,044.15, this hospital’s rate is 0.92x the Medicare baseline. Located in 907 E Lamar Alexander Parkway, Maryville, TN.

Cash / Self-Pay

$30,753

Average discount available for prompt cash payment at this facility.

Insurance Median

$12,880

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: $30,753 (219%)

Insurance Median: $12,880 (92%)

Cash: $30,753 (219% of Medicare)

Ins. Median: $12,880 (92% 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 - $12,018	40%
UnitedHealthcare	$5,652 - $14,842	40%
Golden Rule Insurance Company [2991]	$6,762	48%
Oxford Health Plans [2992]	$6,762	48%
Cigna	$9,315 - $14,914	66%
Mvp Health Care [3037]	$9,315	66%
Blue Cross Blue Shield	$12,880 - $13,396	92%
Humana	$12,880	92%
Medicare (plans)	$12,880 - $14,914	92%
Ambetter / Centene	$22,444	160%
Consociate Health Contracted [4835]	$26,064	186%
Bob Jones Univ-Pai [821]	$30,920	220%
Fairos/Occunet Contracted [4837]	$31,856	227%
Preferred Administrators Contracted [2839]	$34,253	244%
Promise Health Plan Contracted [2401]	$37,614	268%

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 $30,753.
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 Blount Memorial 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.