Hip or knee replacement (inpatient stay)
Facility: Methodist Charlton Medical Center
Billing Code: 470 (MS-DRG)
- CPT Billing Code: 470
- Insurance Median: $21,683
- Cash Discount Price: $29,010
- vs. Medicare Baseline: 1.54x 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 | $5,048 - $19,045 | 36% |
| Aetna | $17,967 - $29,106 | 128% |
| Blue Cross Blue Shield | $17,967 - $47,017 | 128% |
| Medicare (plans) | $17,967 - $19,224 | 128% |
| Ust Health Proof [1005] | $17,967 | 128% |
| Wellcare [7016] | $17,967 | 128% |
| Covid19 Hrsa Uninsured Testing And Treatment Fund [6005] | $18,289 | 130% |
| American Health Advantage Of Texas [7099] | $18,865 | 134% |
| Cigna | $18,865 - $21,683 | 134% |
| Globalhealth [1003] | $18,865 | 134% |
| Procare Advantage [7018] | $18,865 | 134% |
| Humana | $19,045 | 136% |
| Southwestern Health Resources Swhr [7015] | $19,045 | 136% |
| Coralvita [9216] | $19,457 | 139% |
| Bright Healthcare [2222] | $19,502 | 139% |
| Provider Partners Health Plan [7025] | $19,763 | 141% |
| Mcs Advantage, Inc Classicare [7021] | $20,302 | 145% |
| Medical Card System [2063] | $20,302 | 145% |
| Web Tpa [3049] | $21,683 | 154% |
| Alternative Service Concepts [8005] | $22,458 | 160% |
| Kempton Group Administrators, Tower Extrusions [3061] | $23,147 | 165% |
| Medicaid / KanCare | $24,025 - $37,559 | 171% |
| Oscar Insurance Company [2057] | $25,153 | 179% |
| Department Of Labor [8004] | $25,692 | 183% |
| Generic Workers Comp Tx Non Par [9010] | $25,692 | 183% |
| Generic Workers Comp Tx Par [8002] | $25,692 | 183% |
| Generic Workers Comp Tx Par [9011] | $25,692 | 183% |
| Molina [3017] | $26,051 | 185% |
| Sana Benefits [3069] | $26,950 | 192% |
| Wellpoint Marketplace Exchange [3071] | $27,848 | 198% |
| 90 Degree Benefit [3057] | $29,645 | 211% |
| Allied National [2031] | $29,645 | 211% |
| Entrust/90 Degree [2058] | $29,645 | 211% |
| Friday Health Plan [2061] | $30,543 | 217% |
| Ambetter / Centene | $30,723 | 219% |
| Imperial Insurance Companies [3073] | $32,340 | 230% |
| Evry Health [1013] | $44,916 | 320% |
| Medical Cost Containment Professionals [3059] | $44,916 | 320% |
| Velocity [3070] | $44,916 | 320% |
| Dart Member Care [3039] | $48,510 | 345% |
| Healthscope Benefits [2052] | $48,510 | 345% |
| Healthscope Benefits [3063] | $48,510 | 345% |