Hip or knee replacement (inpatient stay)
Facility: Methodist Dallas Medical Center
Billing Code: 470 (MS-DRG)
- CPT Billing Code: 470
- Insurance Median: $28,529
- Cash Discount Price: $33,865
- vs. Medicare Baseline: 2.03x Medicare
Average discount available for prompt cash payment at this facility.
Median negotiated contract rate across all mapped commercial carriers.
Standard federal government reimbursement rate for this code.
Visual Cost Comparison vs. 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.
Elevated Commercial Rate Alert (Value-Gap)
The negotiated rate at this facility is 203% of the Medicare baseline (a markup of 103%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.
Out-of-Pocket Cost Estimator
Estimate whether it is more economical to use your insurance or pay the upfront self-pay cash rate.
Commercial Insurance Negotiated Rates
Negotiated contract ranges established by major commercial carriers at this facility.
| Carrier / Plan Group | Contract Rate Range | vs. Medicare Reference |
|---|---|---|
| UnitedHealthcare | $6,706 - $21,601 | 48% |
| Coralvita [9216] | $19,457 | 139% |
| Bright Healthcare [2222] | $19,502 | 139% |
| Aetna | $20,378 - $47,630 | 145% |
| Blue Cross Blue Shield | $20,378 - $47,017 | 145% |
| Medicare (plans) | $20,378 - $21,804 | 145% |
| Ust Health Proof [1005] | $20,378 | 145% |
| Wellcare [7016] | $20,378 | 145% |
| Covid19 Hrsa Uninsured Testing And Treatment Fund [6005] | $21,168 | 151% |
| American Health Advantage Of Texas [7099] | $21,397 | 152% |
| Cigna | $21,397 - $21,683 | 152% |
| Globalhealth [1003] | $21,397 | 152% |
| Procare Advantage [7018] | $21,397 | 152% |
| Humana | $21,601 | 154% |
| Southwestern Health Resources Swhr [7015] | $21,601 | 154% |
| Web Tpa [3049] | $21,683 - $47,630 | 154% |
| Provider Partners Health Plan [7025] | $22,416 | 160% |
| Mcs Advantage, Inc Classicare [7021] | $23,027 | 164% |
| Medical Card System [2063] | $23,027 | 164% |
| Kempton Group Administrators, Tower Extrusions [3061] | $23,147 | 165% |
| Alternative Service Concepts [8005] | $25,472 | 181% |
| Oscar Insurance Company [2057] | $28,529 | 203% |
| Department Of Labor [8004] | $29,140 | 207% |
| Generic Workers Comp Tx Non Par [9010] | $29,140 | 207% |
| Generic Workers Comp Tx Par [8002] | $29,140 | 207% |
| Generic Workers Comp Tx Par [9011] | $29,140 | 207% |
| Molina [3017] | $29,548 | 210% |
| Sana Benefits [3069] | $30,567 | 218% |
| Wellpoint Marketplace Exchange [3071] | $31,586 | 225% |
| Medicaid / KanCare | $31,913 - $49,891 | 227% |
| 90 Degree Benefit [3057] | $33,624 | 239% |
| Allied National [2031] | $33,624 | 239% |
| Entrust/90 Degree [2058] | $33,624 | 239% |
| Friday Health Plan [2061] | $34,643 | 247% |
| Ambetter / Centene | $34,846 | 248% |
| Imperial Insurance Companies [3073] | $36,680 | 261% |
| Scott & White Health Plan Trs [3062] | $42,444 | 302% |
| Evry Health [1013] | $50,945 | 363% |
| Medical Cost Containment Professionals [3059] | $50,945 | 363% |
| Velocity [3070] | $50,945 | 363% |
| Dart Member Care [3039] | $55,020 | 392% |
| Healthscope Benefits [2052] | $55,020 | 392% |
| Healthscope Benefits [3063] | $55,020 | 392% |