{
  "query": {
    "country": "US",
    "service": "knee replacement",
    "state": "TX",
    "setting": null
  },
  "status": "ok",
  "price": {
    "currency": "USD",
    "unit": "per hospital stay (total payment to the hospital, Medicare rates)",
    "value": 15157.440135,
    "measure": "average",
    "median": null,
    "typical_low": null,
    "typical_high": null,
    "min": null,
    "max": null
  },
  "sample_size": 4151,
  "period": {
    "from": "2024-01-01",
    "to": "2024-12-31"
  },
  "confidence": "high",
  "price_type": "official_statistic",
  "statistic": {
    "measure": "average",
    "reference_period": "2024",
    "note": "This is the hospital's total payment for the stay under Medicare (Medicare's payment plus the patient's deductible and co-payments and any other insurer). The surgeon's and other doctors' fees are billed separately and are not in this figure. It is what was paid at Medicare rates, not what private insurance pays or the cash price; private-insurance and cash prices are usually higher. An MS-DRG group mixes patients with different complications: 'without MCC' is the group without a major complication or comorbidity, 'with MCC' the most complex. Other severity levels are listed under other_severity_levels. This group covers hip and knee replacements together; CMS does not publish them separately. The surgeon's fee is billed separately: for code 27447 Medicare allowed an average of $1,260 in a facility setting (35,139 services). Ask again with setting=facility for that figure."
  },
  "as_of": "2026-10-14T21:16:22.886Z",
  "source": {
    "id": "us-cms-inpatient",
    "name": "Medicare Inpatient Hospitals - by Geography and Service",
    "publisher": "Centers for Medicare & Medicaid Services (CMS)",
    "licence": "U.S. Government Works (the licence the Data.gov catalog lists for this dataset; no separate licence is stated on data.cms.gov). MS-DRG codes and titles are the Medicare payment classification published by CMS (they are not AMA CPT codes).",
    "licence_url": "https://www.usa.gov/government-works",
    "attribution": "Source: Centers for Medicare & Medicaid Services, Medicare Inpatient Hospitals - by Geography and Service (data.cms.gov). Amounts are what hospitals were paid for Medicare fee-for-service stays, passed on as published.",
    "url": "https://data.cms.gov/provider-summary-by-type-of-service/medicare-inpatient-hospitals/medicare-inpatient-hospitals-by-geography-and-service"
  },
  "method": "CMS publishes, once a year, the average total payment to hospitals for Medicare fee-for-service stays in each MS-DRG group, by state and for the nation (dataset Medicare Inpatient Hospitals - by Geography and Service). ProofPrice returns the published average for the latest data year, unchanged, with the number of discharges behind it, the share Medicare itself paid, the national average and the other severity levels of the same condition. No range is calculated: CMS gives one average per group and place. It is what hospitals were paid under Medicare, not a private-insurance or cash price, and it does not include the surgeon's or other doctors' fees.",
  "method_url": "https://proofprice.com/method",
  "summary": "For knee replacement (MS-DRG 470: major hip and knee joint replacement or reattachment of lower extremity without MCC) in Texas, hospitals were paid an average of $15,157 per Medicare stay in 2024, across 4,151 discharges. Medicare itself paid $11,958 of that on average; the patient's share and any other insurer cover the rest. The national average is $17,364. This is the hospital's payment at Medicare rates (Medicare's payment plus the patient's cost-sharing), not a private-insurance or cash price and not the hospital's billed (list) charge, and it excludes the surgeon's fee. Official average published by Centers for Medicare & Medicaid Services (CMS) for 2024.",
  "notice": "Information, not a valuation or offer. Ranges describe past recorded prices.",
  "extra": {
    "drg": "470",
    "drg_title": "MAJOR HIP AND KNEE JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY WITHOUT MCC",
    "service": "knee replacement",
    "code_system": "MS-DRG (Medicare Severity Diagnosis Related Group)",
    "what_it_is": "average total payment to the hospital for a Medicare stay, at Medicare rates; not a private-insurance or cash price",
    "geography": {
      "level": "State",
      "name": "Texas",
      "code": "TX"
    },
    "setting": "inpatient",
    "average_total_payment": 15157.44,
    "average_medicare_payment": 11957.89,
    "discharges": 4151,
    "average_billed_charge_not_a_price_paid": 116220.35,
    "national": {
      "average_total_payment": 17364.02,
      "discharges": 64419
    },
    "other_severity_levels": [
      {
        "drg": "469",
        "title": "major hip and knee joint replacement or reattachment of lower extremity with MCC or tota",
        "average_total_payment": 25716.3,
        "discharges": 332
      }
    ],
    "data_year": 2024,
    "dataset": {
      "name": "Medicare Inpatient Hospitals - by Geography and Service",
      "id": "2941ab09-8cee-49d8-9703-f3c5b854e388",
      "url": "https://data.cms.gov/provider-summary-by-type-of-service/medicare-inpatient-hospitals/medicare-inpatient-hospitals-by-geography-and-service"
    },
    "notes": [
      "This is the hospital's total payment for the stay under Medicare (Medicare's payment plus the patient's deductible and co-payments and any other insurer). The surgeon's and other doctors' fees are billed separately and are not in this figure.",
      "It is what was paid at Medicare rates, not what private insurance pays or the cash price; private-insurance and cash prices are usually higher.",
      "An MS-DRG group mixes patients with different complications: 'without MCC' is the group without a major complication or comorbidity, 'with MCC' the most complex. Other severity levels are listed under other_severity_levels.",
      "This group covers hip and knee replacements together; CMS does not publish them separately.",
      "The surgeon's fee is billed separately: for code 27447 Medicare allowed an average of $1,260 in a facility setting (35,139 services). Ask again with setting=facility for that figure."
    ],
    "surgeons_fee_billed_separately": {
      "code": "27447",
      "setting": "facility",
      "average_medicare_allowed_amount": 1260.38,
      "services": 35139
    }
  },
  "answer_id": "ans_48693b48f137b4123f76",
  "method_version": "1",
  "retrieved_at": "2026-10-14T21:16:22.886Z",
  "evidence": {
    "type": "official_statistic",
    "label": "Official published average",
    "meaning": "One average or median that a statistics office or regulator publishes for a reference period: it describes a group, not a distribution, and says nothing about any single price."
  }
}