CMS Price Transparency Data

Hip or knee replacement (inpatient stay)

Facility: Christus Spohn Hospital Alice

Billing Code: 470 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 470
Insurance Median: $12,582
Cash Discount Price: Unavailable
vs. Medicare Baseline: 0.90x Medicare

The contracted insurance negotiated median rate for a Hip or knee replacement (inpatient stay) at Christus Spohn Hospital Alice is $12,582. 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 0.90x the Medicare baseline. Located in 2500 E Main Street, Alice, TX.

Cash / Self-Pay

Unavailable

Average discount available for prompt cash payment at this facility.

Insurance Median

$12,582

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: $12,582 (90%)

Ins. Median: $12,582 (90% 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
Aetna	$2,910 - $12,582	21%
Healthcare Highways	$3,503	25%
UnitedHealthcare	$3,885 - $12,582	28%
Five Point Credit Union	$4,190 - $10,056	30%
Multiplan	$9,371	67%
Phcs	$9,371	67%
Christus Health	$11,953 - $17,614	85%
Allwell	$12,582	90%
Blue Cross Blue Shield	$12,582 - $27,012	90%
Coventry	$12,582	90%
Humana	$12,582 - $28,160	90%
Molina	$12,582	90%
Superior	$12,582	90%
Texas Healthspring	$12,582	90%
Triwest	$12,582	90%
Wellcare	$12,582	90%
Provider Partners Health Plan	$12,959	92%
Texas Independence Health Plan	$12,959	92%
Shared Health Insurance Company	$13,211	94%
Us Imaging Network	$13,462	96%
Amerigroup	$13,588	97%
Devoted Health Plan	$13,588	97%
Imperial Health Plan	$13,840	99%
Medicare (plans)	$13,840	99%
Procare Advantage	$13,840	99%
Cigna	$16,502 - $20,179	118%
Naphcare Inc.	$28,938	206%
Healthsmart	$36,261	258%

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 Christus Spohn Hospital Alice 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.