CMS Price Transparency Data

Hip or knee replacement (inpatient stay)

Facility: Valley Regional Medical Center

Billing Code: 470 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 470
Insurance Median: $18,456
Cash Discount Price: Unavailable
vs. Medicare Baseline: 1.31x Medicare

The contracted insurance negotiated median rate for a Hip or knee replacement (inpatient stay) at Valley Regional Medical Center is $18,456. 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 1.31x the Medicare baseline. Located in 100 A Alton Gloor, Brownsville, TX.

Cash / Self-Pay

Unavailable

Average discount available for prompt cash payment at this facility.

Insurance Median

$18,456

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: $18,456 (131%)

Ins. Median: $18,456 (131% 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
First Health	$2,258 - $2,346	16%
United	$2,533 - $41,688	18%
Aetna	$12,976 - $27,933	92%
Humana	$16,786 - $46,693	120%
Cigna	$17,401 - $40,088	124%
Blue Cross Blue Shield	$17,577 - $51,584	125%
Texas Healthcare Foundation	$17,577	125%
Triwest Healthcare Alliance	$17,577	125%
Provider Partners Health Plan Of Texas	$17,928	128%
Wellmed	$17,928	128%
Physicians Health Choice	$18,104	129%
American Health Plan	$18,456	131%
Prominence Health	$18,456	131%
Superior Health Plan	$18,456	131%
Texas Independent Health Plan	$18,456	131%
Molina	$19,159	136%
Shared Health	$21,092	150%
Oscar	$24,015	171%
Corvel Corporation	$24,884	177%
Molina Healthcare	$25,975	185%
Curative Administrators	$26,326	187%
Omni Healthcare	$26,392	188%
Independent Medical System	$26,879	191%
Superior	$27,244	194%

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 Valley Regional 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.