CMS Price Transparency Data

Hip or knee replacement (inpatient stay)

Facility: Doctors Hosptal at Renaissance

Billing Code: 470 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 470
Insurance Median: $14,655
Cash Discount Price: $12,743
vs. Medicare Baseline: 1.04x Medicare

The contracted insurance negotiated median rate for a Hip or knee replacement (inpatient stay) at Doctors Hosptal at Renaissance is $14,655. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $12,743. Compared to the federal Medicare reimbursement reference rate of $14,044.15, this hospital’s rate is 1.04x the Medicare baseline. Located in 5501 South McColl, Edinburg, TX.

Cash / Self-Pay

$12,743

Average discount available for prompt cash payment at this facility.

Insurance Median

$14,655

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%)

Cash / Self-Pay: $12,743 (91%)

Insurance Median: $14,655 (104%)

Cash: $12,743 (91% of Medicare)

Ins. Median: $14,655 (104% 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
Humana	$12,743	91%
Blue Cross Blue Shield	$12,998 - $26,381	93%
Molina	$13,380 - $15,929	95%
Superior	$13,380 - $15,929	95%
Wellcare	$13,380	95%
Cl Frates	$20,253	144%
Healthsmart	$28,934	206%

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 $12,743.
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 Doctors Hosptal at Renaissance 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.