CMS Price Transparency Data

Hip or knee replacement (inpatient stay)

Facility: North Texas Medical Center

Billing Code: 470 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 470
Insurance Median: $7,172
Cash Discount Price: $16,608
vs. Medicare Baseline: 0.51x Medicare

The contracted insurance negotiated median rate for a Hip or knee replacement (inpatient stay) at North Texas Medical Center is $7,172. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $16,608. Compared to the federal Medicare reimbursement reference rate of $14,044.15, this hospital’s rate is 0.51x the Medicare baseline. Located in 1900 Hospital Blvd, Gainesville, TX.

Cash / Self-Pay

$16,608

Average discount available for prompt cash payment at this facility.

Insurance Median

$7,172

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: $16,608 (118%)

Insurance Median: $7,172 (51%)

Cash: $16,608 (118% of Medicare)

Ins. Median: $7,172 (51% 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
90 Degree Benefits	$6,672	48%
Aetna	$6,672 - $41,188	48%
Blue Cross Blue Shield	$6,672 - $33,216	48%
Humana	$6,672	48%
Prime Health	$6,672 - $59,789	48%
Prominence Health	$6,672 - $7,005	48%
Superior	$6,672 - $7,339	48%
UnitedHealthcare	$6,672 - $45,838	48%
Wellmed	$6,672	48%
Wellpoint	$6,672	48%
Providers Partners Health Plan	$7,005	50%
Molina	$7,339 - $8,006	52%
Cigna	$39,859	284%
First Health	$39,859	284%
Healthcare Highways	$39,859	284%
Provider Select	$56,467	402%

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 $16,608.
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 North Texas 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.