Hip or knee replacement (inpatient stay)
Facility: Methodist Richardson Medical Center
Billing Code: 470 (MS-DRG)
- CPT Billing Code: 470
- Insurance Median: $19,480
- Cash Discount Price: $31,196
- vs. Medicare Baseline: 1.39x 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.
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 | $4,936 - $17,187 | 35% |
| Aetna | $16,215 - $33,012 | 115% |
| Blue Cross Blue Shield | $16,215 - $51,222 | 115% |
| Covid19 Hrsa Uninsured Testing And Treatment Fund [6005] | $16,215 | 115% |
| Medicare (plans) | $16,215 - $17,350 | 115% |
| Ust Health Proof [1005] | $16,215 | 115% |
| Wellcare [7016] | $16,215 | 115% |
| American Health Advantage Of Texas [7099] | $17,025 | 121% |
| Cigna | $17,025 - $21,683 | 121% |
| Globalhealth [1003] | $17,025 | 121% |
| Procare Advantage [7018] | $17,025 | 121% |
| Humana | $17,187 | 122% |
| Southwestern Health Resources Swhr [7015] | $17,187 | 122% |
| Provider Partners Health Plan [7025] | $17,836 | 127% |
| Mcs Advantage, Inc Classicare [7021] | $18,322 | 130% |
| Medical Card System [2063] | $18,322 | 130% |
| Coralvita [9216] | $19,457 | 139% |
| Bright Healthcare [2222] | $19,502 | 139% |
| Alternative Service Concepts [8005] | $20,268 | 144% |
| 90 Degree Benefit [3057] | $20,378 | 145% |
| Allied National [2031] | $20,378 | 145% |
| Ambetter / Centene | $20,378 | 145% |
| Entrust/90 Degree [2058] | $20,378 | 145% |
| Web Tpa [3049] | $21,683 | 154% |
| Oscar Insurance Company [2057] | $22,700 | 162% |
| Medicaid / KanCare | $23,491 - $36,724 | 167% |
| Molina [3017] | $23,511 | 167% |
| Sana Benefits [3069] | $24,322 | 173% |
| Imperial Insurance Companies [3073] | $29,186 | 208% |
| Wellpoint Marketplace Exchange [3071] | $31,586 | 225% |
| Friday Health Plan [2061] | $34,643 | 247% |
| Evry Health [1013] | $40,536 | 289% |
| Medical Cost Containment Professionals [3059] | $40,536 | 289% |
| Dart Member Care [3039] | $43,779 | 312% |
| Healthscope Benefits [2052] | $43,779 | 312% |
| Healthscope Benefits [3063] | $43,779 | 312% |
| Velocity [3070] | $50,945 | 363% |