CMS Price Transparency Data

Hip or knee replacement (inpatient stay)

Facility: Methodist McKinney Hospital

Billing Code: 470 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 470
Insurance Median: $19,387
Cash Discount Price: $28,623
vs. Medicare Baseline: 1.38x Medicare

The contracted insurance negotiated median rate for a Hip or knee replacement (inpatient stay) at Methodist McKinney Hospital is $19,387. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $28,623. Compared to the federal Medicare reimbursement reference rate of $14,044.15, this hospital’s rate is 1.38x the Medicare baseline. Located in 8000 W Eldorado Pkwy Bldg C Suite C, McKinney, TX.

Cash / Self-Pay

$28,623

Average discount available for prompt cash payment at this facility.

Insurance Median

$19,387

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: $28,623 (204%)

Insurance Median: $19,387 (138%)

Cash: $28,623 (204% of Medicare)

Ins. Median: $19,387 (138% 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	$13,291 - $32,178	95%
Blue Cross Blue Shield	$13,291 - $31,378	95%
Medicare (plans)	$13,291 - $14,221	95%
UnitedHealthcare	$13,291 - $14,088	95%
Ust Health Proof [1005]	$13,291	95%
Wellcare [7016]	$13,291	95%
American Health Advantage Of Texas [7099]	$13,955	99%
Cigna	$13,955 - $21,683	99%
Globalhealth [1003]	$13,955	99%
Procare Advantage [7018]	$13,955	99%
Humana	$14,088	100%
Southwestern Health Resources Swhr [7015]	$14,088	100%
Provider Partners Health Plan [7025]	$14,620	104%
Mcs Advantage, Inc Classicare [7021]	$15,019	107%
Medical Card System [2063]	$15,019	107%
Alternative Service Concepts [8005]	$16,613	118%
Oscar Insurance Company [2057]	$18,607	132%
Molina [3017]	$19,272	137%
Bright Healthcare [2222]	$19,502	139%
Champva [1000]	$19,833	141%
Tricare	$19,833	141%
Triwest Wps [8010]	$19,833	141%
Veterans Administration [9001]	$19,833	141%
Sana Benefits [3069]	$19,936	142%
Wellpoint Marketplace Exchange [3071]	$20,601	147%
Web Tpa [3049]	$21,683 - $32,178	154%
90 Degree Benefit [3057]	$21,930	156%
Allied National [2031]	$21,930	156%
Entrust/90 Degree [2058]	$21,930	156%
Friday Health Plan [2061]	$22,594	161%
Ambetter / Centene	$22,727	162%
Imperial Insurance Companies [3073]	$23,923	170%
Evry Health [1013]	$33,227	237%
Velocity [3070]	$33,227	237%

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 $28,623.
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 Methodist McKinney Hospital 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.