Hip or knee replacement (inpatient stay)
Facility: Texas Orthopedic Hospital
Billing Code: 470 (MS-DRG)
- CPT Billing Code: 470
- Insurance Median: $14,550
- Cash Discount Price: Unavailable
- vs. Medicare Baseline: 1.04x 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 |
|---|---|---|
| Aetna | $1,779 - $52,910 | 13% |
| Coventry National First Health | $1,941 - $19,024 | 14% |
| United | $3,368 - $52,000 | 24% |
| Humana | $13,364 - $28,297 | 95% |
| Oscar | $13,516 - $22,549 | 96% |
| Cigna | $13,654 - $62,143 | 97% |
| Wellmed | $13,654 | 97% |
| Amerigroup | $13,791 | 98% |
| Blue Cross Blue Shield | $13,791 - $37,734 | 98% |
| Kelsey Seybold | $13,791 | 98% |
| Texas Healthcare Foundation | $13,791 | 98% |
| Triwest Healthcare Alliance | $13,791 | 98% |
| Van Lang Ipa | $13,929 | 99% |
| Devoted Health | $14,067 | 100% |
| Integranet Amerigroup Ipa | $14,067 | 100% |
| Provider Partners Health Plan Of Texas | $14,067 | 100% |
| American Health Plan | $14,481 | 103% |
| Procare Advantage | $14,481 | 103% |
| Superior Health Plan | $14,481 | 103% |
| Texas Independent Health Plan | $14,619 | 104% |
| Wellcare | $14,619 | 104% |
| Universal Healthcare Group | $14,895 | 106% |
| Molina | $15,033 | 107% |
| Fidelis Securecare Of Tx | $15,446 | 110% |
| Shared Health | $16,550 | 118% |
| Verda Health Plan | $16,550 | 118% |
| Averde Health | $17,360 | 124% |
| Imagine Health | $19,137 | 136% |
| Corvel Corporation | $19,525 | 139% |
| Community Health Choice | $19,998 | 142% |
| Omni Healthcare | $20,708 | 147% |
| Superior | $21,377 | 152% |
| Healthcare Highways | $23,469 | 167% |
| Curative Administrators | $26,326 | 187% |
| Evry Health | $26,964 | 192% |
| Molina Healthcare | $28,710 | 204% |