CMS Price Transparency Data

Hip or knee replacement (inpatient stay)

Facility: Houston Methodist Clear Lake Hospital

Billing Code: 470 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 470
Insurance Median: $17,191
Cash Discount Price: Unavailable
vs. Medicare Baseline: 1.22x Medicare

The contracted insurance negotiated median rate for a Hip or knee replacement (inpatient stay) at Houston Methodist Clear Lake Hospital is $17,191. 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 1.22x the Medicare baseline. Located in 18300 St John Drive, Nassau Bay, TX.

Cash / Self-Pay

Unavailable

Average discount available for prompt cash payment at this facility.

Insurance Median

$17,191

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: $17,191 (122%)

Ins. Median: $17,191 (122% 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
Blue Cross Blue Shield	$15,628 - $28,630	111%
Humana	$15,628	111%
Triwest Healthcare	$15,628	111%
UnitedHealthcare	$15,628 - $41,561	111%
Aetna	$15,862	113%
Cigna	$16,097 - $24,998	115%
Wellpoint	$16,097	115%
Molina Healthcare	$16,409 - $31,256	117%
Oscar	$16,409	117%
Community Health Choice	$16,722 - $29,693	119%
Devoted Health	$16,722 - $19,535	119%
Procare Advantage	$17,191 - $19,535	122%
Texas Annual Conference	$25,474 - $29,693	181%
Entrust	$28,554	203%
Phcs	$88,050	627%

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 Houston Methodist Clear Lake Hospital 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.