CMS Price Transparency Data

Hip or knee replacement (inpatient stay)

Facility: Dallas Regional Medical Center

Billing Code: 470 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 470
Insurance Median: $18,789
Cash Discount Price: $17,724
vs. Medicare Baseline: 1.34x Medicare

The contracted insurance negotiated median rate for a Hip or knee replacement (inpatient stay) at Dallas Regional Medical Center is $18,789. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $17,724. Compared to the federal Medicare reimbursement reference rate of $14,044.15, this hospital’s rate is 1.34x the Medicare baseline. Located in 1011 North Galloway Avenue, Mesquite, TX.

Cash / Self-Pay

$17,724

Average discount available for prompt cash payment at this facility.

Insurance Median

$18,789

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: $17,724 (126%)

Insurance Median: $18,789 (134%)

Cash: $17,724 (126% of Medicare)

Ins. Median: $18,789 (134% 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
Careworks Fka (Rockport Community Network) Workercomp	$16,839	120%
Blue Cross Blue Shield	$17,370 - $28,024	124%
Aetna	$17,725 - $26,587	126%
Care N Care Insurance Company	$17,725	126%
Cigna	$17,725 - $18,257	126%
Corporate Remedies Workers Comp	$17,725	126%
Medicare (plans)	$17,725	126%
Superior Health Plan/Wellcare	$17,725 - $23,042	126%
Texas Bluebonnett Health Plan	$17,725 - $29,246	126%
UnitedHealthcare	$17,725	126%
Usa Senior Care Network	$17,725	126%
Wellmed	$17,725	126%
Wellpoint Amerigroup	$17,725	126%
Molina	$18,611	133%
Multiplan	$18,611	133%
Provider Partners Health Plan	$18,611	133%
Imperial Insurance Companies Mcr	$18,788	134%
Tricare	$18,996	135%
Worker Compensation	$19,143 - $25,347	136%
American Health Plan	$19,497	139%
Hi Card	$22,156	158%
Employee Direct Healthcare	$23,042	164%
Total Plans Srvices	$24,815	177%
Wellpath	$25,701	183%
American Correction Healthcare	$26,587	189%
Naphcare -Prison	$27,474	196%
National Healthcare Solutions	$28,360	202%
Elap Services	$29,246	208%

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 $17,724.
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 Dallas 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.