CMS Price Transparency Data

Hip or knee replacement (inpatient stay)

Facility: Banner Heart Hospital

Billing Code: 470 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 470
Insurance Median: $14,702
Cash Discount Price: $20,648
vs. Medicare Baseline: 1.05x Medicare

The contracted insurance negotiated median rate for a Hip or knee replacement (inpatient stay) at Banner Heart Hospital is $14,702. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $20,648. Compared to the federal Medicare reimbursement reference rate of $14,044.15, this hospital’s rate is 1.05x the Medicare baseline. Located in 6750 East Baywood Avenue, Mesa, AZ.

Cash / Self-Pay

$20,648

Average discount available for prompt cash payment at this facility.

Insurance Median

$14,702

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: $20,648 (147%)

Insurance Median: $14,702 (105%)

Cash: $20,648 (147% of Medicare)

Ins. Median: $14,702 (105% 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	$14,002 - $50,190	100%
Arizona Physicians Ipa	$14,002	100%
Banner Health	$14,002	100%
Banner University Health Plan	$14,002	100%
Blue Cross Blue Shield	$14,002 - $60,279	100%
Care 1St	$14,002	100%
Cigna	$14,002 - $57,065	100%
Gila River Health Care Corporation	$14,002	100%
Health Choice Arizona, Inc.	$14,002 - $21,003	100%
Health Net	$14,002 - $20,723	100%
Humana	$14,002 - $14,422	100%
Kaiser Foundation Health Plan	$14,002	100%
Mercy Care	$14,002	100%
Triwest Healthcare Alliance Corp - Va Ccn	$14,002	100%
UnitedHealthcare	$14,002 - $50,000	100%
Upmc Health Plan	$14,002	100%
Wellpoint	$14,002	100%
Carelon	$14,702	105%
Devoted Health Services	$14,702	105%
Arizona Priority Care	$15,402	110%
Gold Kidney Health Plan	$15,402	110%
Oscar Health Plan	$23,103	165%

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 $20,648.
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 Heart Hospital 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.