CMS Price Transparency Data

Hip or knee replacement (inpatient stay)

Facility: Banner - University Medical Center Phoenix

Billing Code: 470 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 470
Insurance Median: $20,637
Cash Discount Price: $29,938
vs. Medicare Baseline: 1.47x Medicare

The contracted insurance negotiated median rate for a Hip or knee replacement (inpatient stay) at Banner - University Medical Center Phoenix is $20,637. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $29,938. Compared to the federal Medicare reimbursement reference rate of $14,044.15, this hospital’s rate is 1.47x the Medicare baseline. Located in 1111 East McDowell Road, Phoenix, AZ.

Cash / Self-Pay

$29,938

Average discount available for prompt cash payment at this facility.

Insurance Median

$20,637

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: $29,938 (213%)

Insurance Median: $20,637 (147%)

Cash: $29,938 (213% of Medicare)

Ins. Median: $20,637 (147% 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	$18,426 - $47,780	131%
Arizona Physicians Ipa	$18,426	131%
Banner Health	$18,426	131%
Banner University Health Plan	$18,426	131%
Blue Cross Blue Shield	$18,426 - $72,249	131%
Care 1St	$18,426	131%
Gila River Health Care Corporation	$18,426	131%
Health Choice Arizona, Inc.	$18,426 - $27,639	131%
Health Net	$18,426 - $27,270	131%
Kaiser Foundation Health Plan	$18,426	131%
Mercy Care	$18,426	131%
Triwest Healthcare Alliance Corp - Va Ccn	$18,426	131%
UnitedHealthcare	$18,426 - $50,000	131%
Upmc Health Plan	$18,426	131%
Wellpoint	$18,426	131%
Humana	$18,979	135%
Carelon	$19,347	138%
Devoted Health Services	$19,347	138%
Arizona Priority Care	$20,269	144%
Gold Kidney Health Plan	$20,269	144%
Naphcare	$29,482	210%
Oscar Health Plan	$30,403	216%
Cigna	$51,359 - $57,065	366%

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 $29,938.
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 Banner - University Medical Center Phoenix 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.