CMS Price Transparency Data

Hip or knee replacement (inpatient stay)

Facility: Southern Hills Hospital and Medical Center

Billing Code: 470 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 470
Insurance Median: $20,182
Cash Discount Price: Unavailable
vs. Medicare Baseline: 1.44x Medicare

The contracted insurance negotiated median rate for a Hip or knee replacement (inpatient stay) at Southern Hills Hospital and Medical Center is $20,182. 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 1.44x the Medicare baseline. Located in 9300 West Sunset Rd, Las Vegas, NV.

Cash / Self-Pay

Unavailable

Average discount available for prompt cash payment at this facility.

Insurance Median

$20,182

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: $20,182 (144%)

Ins. Median: $20,182 (144% 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
Molina Healthcare	$1,550	11%
Sierra	$2,602 - $21,125	19%
Humana	$3,148 - $21,527	22%
Multiplan	$3,186	23%
First Health	$3,456	25%
United	$3,574 - $27,468	25%
Hometown Health Providers	$3,784 - $28,799	27%
Select Health	$3,864 - $47,537	28%
Health Services Coalition	$3,896 - $31,390	28%
Prominence Healthfirst	$4,095	29%
Aetna	$4,123 - $27,193	29%
Cigna	$4,347 - $57,423	31%
Blue Cross Blue Shield	$4,514 - $42,687	32%
Procare Hospice	$17,685 - $18,298	126%
Unified Care Hospice	$17,685 - $18,298	126%
Hometown Health McR	$20,182 - $20,882	144%
Triwest	$20,806 - $21,527	148%
Ambetter / Centene	$20,806 - $38,749	148%
Alignment Health Plan	$20,806 - $21,527	148%
Caremore	$21,222 - $21,958	151%
Imperial Nv	$21,846 - $22,604	156%
Universal Healthcare	$22,262 - $23,034	159%

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 Southern Hills Hospital and Medical Center 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.