CMS Price Transparency Data

Hip or knee replacement (inpatient stay)

Facility: Texas Health Harris Methodist Hospital Cleburne

Billing Code: 470 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 470
Insurance Median: $32,059
Cash Discount Price: Unavailable
vs. Medicare Baseline: 2.28x Medicare

The contracted insurance negotiated median rate for a Hip or knee replacement (inpatient stay) at Texas Health Harris Methodist Hospital Cleburne is $32,059. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is unavailable. Compared to the federal Medicare reimbursement reference rate of $14,044.15, this hospital’s rate is 2.28x the Medicare baseline. Located in 201 Walls Drive, Cleburne, TX.

Cash / Self-Pay

Unavailable

Average discount available for prompt cash payment at this facility.

Insurance Median

$32,059

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%)

Insurance Median: $32,059 (228%)

Ins. Median: $32,059 (228% 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.

Elevated Commercial Rate Alert (Value-Gap)

The negotiated rate at this facility is 228% of the Medicare baseline (a markup of 128%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.

Consult Patient Advocate

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
American Health	$18,182	129%
Blue Cross Blue Shield	$18,182 - $156,625	129%
Healthspring	$18,546	132%
Humana	$18,910	135%
Amerigroup	$19,092	136%
Molina	$19,092	136%
Superior Wellcare	$19,092 - $20,001	136%
UnitedHealthcare	$20,183 - $65,689	144%
Aetna	$32,059 - $42,744	228%
Fort Worth Firefighters	$38,223	272%
Cigna	$45,593 - $63,081	325%

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 $X.
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 Texas Health Harris Methodist Hospital Cleburne 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.