CMS Price Transparency Data

Hip or knee replacement (inpatient stay)

Facility: Banner - University Medical Center Tucson Campus

Billing Code: 470 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 470
Insurance Median: $21,187
Cash Discount Price: $24,630
vs. Medicare Baseline: 1.51x Medicare

The contracted insurance negotiated median rate for a Hip or knee replacement (inpatient stay) at Banner - University Medical Center Tucson Campus is $21,187. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $24,630. Compared to the federal Medicare reimbursement reference rate of $14,044.15, this hospital’s rate is 1.51x the Medicare baseline. Located in 1625 North Campbell Avenue, Tucson, AZ.

Cash / Self-Pay

$24,630

Average discount available for prompt cash payment at this facility.

Insurance Median

$21,187

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: $24,630 (175%)

Insurance Median: $21,187 (151%)

Cash: $24,630 (175% of Medicare)

Ins. Median: $21,187 (151% 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	$20,179 - $34,384	144%
Arizona Physicians Ipa	$20,179	144%
Banner Health	$20,179	144%
Banner University Health Plan	$20,179	144%
Blue Cross Blue Shield	$20,179 - $54,319	144%
Care 1St	$20,179	144%
Cigna	$20,179 - $34,484	144%
Gila River Health Care Corporation	$20,179	144%
Health Choice Arizona, Inc.	$20,179 - $30,268	144%
Health Net	$20,179 - $29,864	144%
Humana	$20,179 - $20,784	144%
Kaiser Foundation Health Plan	$20,179	144%
Mercy Care	$20,179	144%
Triwest Healthcare Alliance Corp - Va Ccn	$20,179	144%
UnitedHealthcare	$20,179 - $35,312	144%
Upmc Health Plan	$20,179	144%
Wellpoint	$20,179	144%
Carelon	$21,187	151%
Devoted Health Services	$21,187	151%
Arizona Priority Care	$22,196	158%
Gold Kidney Health Plan	$22,196	158%
Naphcare	$32,286	230%
Oscar Health Plan	$33,295	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 $24,630.
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 Tucson Campus 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.