CMS Price Transparency Data
Hip or knee replacement (inpatient stay)
Facility: Ohio Valley Surgical Hospital
Billing Code: 470 (MS-DRG)
Factual Cost Summary (Answer Capsule)
- CPT Billing Code: 470
- Insurance Median: $258
- Cash Discount Price: $189
- vs. Medicare Baseline: 0.02x Medicare
The contracted insurance negotiated median rate for a Hip or knee replacement (inpatient stay) at Ohio Valley Surgical Hospital is $258. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $189. Compared to the federal Medicare reimbursement reference rate of $14,044.15, this hospital’s rate is 0.02x the Medicare baseline. Located in 100 West Main Street, Springfield, OH.
Cash / Self-Pay
$189
Average discount available for prompt cash payment at this facility.
Insurance Median
$258
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: $189 (1%)
Insurance Median: $258 (2%)
Cash: $189 (1% of Medicare)
Ins. Median: $258 (2% 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.
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 |
|---|---|---|
| Mmoh | $1,406 - $13,168 | 10% |
| Mmo Cin. HMO | $1,407 - $13,168 | 10% |
| Preferred Health | $1,408 - $18,811 | 10% |
| Medben | $1,408 - $18,811 | 10% |
| Luminare Health | $1,408 - $18,811 | 10% |
| Ohio Health | $1,408 - $18,811 | 10% |
| Mmoh (Supermed) | $1,410 - $9,719 | 10% |
| Blue Cross Blue Shield | $3,557 - $40,293 | 25% |
| Medicaid / KanCare | $3,557 - $17,827 | 25% |
| Amerihealth Caritas of Ohio | $3,657 | 26% |
| Buckeye Community Health Plan | $4,022 | 29% |
| UnitedHealthcare | $4,022 - $17,571 | 29% |
| Aetna | $4,022 - $20,896 | 29% |
| Molina McD | $4,084 | 29% |
| Caresource | $4,364 - $17,827 | 31% |
| Humana | $4,493 - $11,919 | 32% |
| Gateway Health Plan | $11,885 | 85% |
| Aultcare Primetime Health Plan | $11,885 | 85% |
| Bankers Fidelity | $11,885 | 85% |
| Self Pay Imaging | $11,885 | 85% |
| Champus | $11,885 | 85% |
| Communicare Advantage | $11,885 | 85% |
| Medicare (plans) | $11,885 - $12,264 | 85% |
| Central States | $11,885 | 85% |
| Prosperity Supplement | $11,885 | 85% |
| Molina | $11,885 | 85% |
| Cigna | $11,885 - $18,817 | 85% |
| Everest | $11,885 | 85% |
| Molina Dual McR | $11,885 | 85% |
| American Continental Life | $11,885 | 85% |
| Molina McR | $11,885 | 85% |
| Aarp Supplemental | $11,885 | 85% |
| Patient No Pay | $11,885 | 85% |
| Wraparound Pl Supp | $11,885 | 85% |
| American Republic | $11,885 | 85% |
| Molina Marketplace | $11,885 | 85% |
| Molina McR+McD | $11,885 | 85% |
| American Retirement | $11,885 | 85% |
| American Continental Insurance | $11,885 | 85% |
| Molina Dual McR | $11,885 | 85% |
| Aarp | $11,885 | 85% |
| Wellcare By Allwell | $11,885 | 85% |
| Medigold | $11,885 | 85% |
| Bankers Life and Casualty | $11,885 | 85% |
| Molina McR McD | $11,885 | 85% |
| The Health Plan | $12,479 | 89% |
| Devoted Health | $13,707 | 98% |
| Employer Direct | $15,703 | 112% |
| Surest | $17,571 | 125% |
| Oxford | $17,571 | 125% |
| Medica | $17,571 | 125% |
| Geha | $17,571 - $20,896 | 125% |
| Shl | $17,571 | 125% |
| Ushealth | $17,571 | 125% |
| Golden Rule | $17,571 | 125% |
| Caresourse | $17,827 | 127% |
| Sbma | $18,817 | 134% |
| Samba | $18,817 | 134% |
| Nalc | $18,817 | 134% |
| Healthgram | $18,817 | 134% |
| Unified Group | $18,817 | 134% |
| Personify Health | $20,896 | 149% |
| Genworth | $20,896 | 149% |
| Meritain Heatlh | $20,896 | 149% |
| Pacific Source | $20,896 | 149% |
| Mhbp | $20,896 | 149% |
| Nippon Life | $20,896 | 149% |
| Ngs Coresource | $20,896 | 149% |
| Mail Handlers | $20,896 | 149% |
| Meritain | $20,896 | 149% |