CMS Price Transparency Data

Hip or knee replacement (inpatient stay)

Facility: Methodist Hospital Atascosa

Billing Code: 470 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 470
Insurance Median: $18,001
Cash Discount Price: Unavailable
vs. Medicare Baseline: 1.28x Medicare

The contracted insurance negotiated median rate for a Hip or knee replacement (inpatient stay) at Methodist Hospital Atascosa is $18,001. 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 1.28x the Medicare baseline. Located in 1905 Hwy 97 East, Jourdanton, TX.

Cash / Self-Pay

Unavailable

Average discount available for prompt cash payment at this facility.

Insurance Median

$18,001

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: $18,001 (128%)

Ins. Median: $18,001 (128% 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
Aetna	$2,775 - $17,418	20%
United	$2,988 - $33,779	21%
Cigna	$4,062 - $38,382	29%
Wellmed	$17,012	121%
Triwest Va Pccc	$17,295	123%
Gonzaba Medical Group	$17,471	124%
Blue Cross Blue Shield	$17,648 - $50,280	126%
Ilumed	$17,648	126%
Integranet	$17,648	126%
Triwest	$17,648	126%
Clover Insurance	$18,001	128%
Devoted Health	$18,001	128%
Texas Independent Health Plan	$18,001	128%
Wellcare	$18,001	128%
American Health Plan Of Texas	$18,530 - $19,413	132%
Superior Health	$18,530	132%
Imperial Insurance	$18,707	133%
Oscar	$19,231	137%
Focus Healthcare Management	$25,236	180%
Healthcare Highways	$25,461	181%
Evry Health	$25,679	183%
Curative Administrators	$26,326	187%
Focus Health Solutions	$26,401	188%
Valenz	$27,460	196%

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 Methodist Hospital Atascosa 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.