Hip or knee replacement (inpatient stay)
Facility: St David's South Austin Medical Center
Billing Code: 470 (MS-DRG)
- CPT Billing Code: 470
- Insurance Median: $17,269
- Cash Discount Price: Unavailable
- vs. Medicare Baseline: 1.23x 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 |
|---|---|---|
| Phcs | $1,430 | 10% |
| First Health | $2,308 | 16% |
| United | $2,781 - $27,735 | 20% |
| Aetna | $3,463 - $17,604 | 25% |
| Cigna | $4,236 - $38,603 | 30% |
| Moda | $14,382 | 102% |
| Oscar | $14,968 - $16,506 | 107% |
| Altus Hospice (Hospice Of The Hills) | $15,089 | 107% |
| Cella Bella Hospice | $15,089 | 107% |
| Compassionate Care Mcr | $15,089 | 107% |
| Heart To Heart Hospice | $15,089 | 107% |
| Hospice Austin | $15,089 | 107% |
| Hospice Compassus | $15,089 | 107% |
| Silverado Hospice | $15,089 | 107% |
| St David’S Hospice | $15,089 | 107% |
| Wellmed | $16,548 | 118% |
| Angel Heart Hospice | $16,766 | 119% |
| Aseracare Hospice | $16,766 | 119% |
| Blue Cross Blue Shield | $16,766 - $56,272 | 119% |
| Girling Hospice | $16,766 | 119% |
| Harbor Hospice | $16,766 | 119% |
| Lighthouse Hospice, Llc. | $16,766 | 119% |
| Odyssey Hospice | $16,766 | 119% |
| Southern Care Hospice | $16,766 | 119% |
| Texas Home Health Hospice | $16,766 | 119% |
| Triwest Veterans | $16,766 | 119% |
| Vistacare Family Hospice | $16,766 | 119% |
| Wesleyan Homes, Inc. | $16,766 | 119% |
| Devoted Health | $17,101 | 122% |
| Provider Partners Health Plan | $17,101 | 122% |
| American Health Plan Of Texas | $17,604 - $18,442 | 125% |
| Humana | $17,604 | 125% |
| Superior Health Plan | $17,604 - $26,825 | 125% |
| Texas Independent Health Plan | $17,604 | 125% |
| Universal Health | $17,604 | 125% |
| Wellcare | $17,604 | 125% |
| Imperial Insurance | $17,772 | 127% |
| Molina Healthcare | $18,275 | 130% |
| Pyramid Life | $18,442 | 131% |
| Shared Health | $20,119 | 143% |
| Austin Fc | $20,957 | 149% |
| Sendero | $22,634 - $28,669 | 161% |
| Nomi Health | $22,769 - $23,967 | 162% |
| Corvel Corporation | $23,735 | 169% |
| Healthcare Highways | $24,219 - $24,711 | 172% |
| Harbor Health Team | $25,413 | 181% |
| Naphcare | $25,987 | 185% |
| Seven Corners | $25,987 | 185% |
| Moda Health | $26,108 - $26,630 | 186% |
| Curative Administrators | $26,326 | 187% |
| Evry Health | $26,573 | 189% |
| Covenant Management Systems | $31,892 | 227% |