CMS Price Transparency Data

Hip or knee replacement (inpatient stay)

Facility: Banner Behavioral Health Hospital

Billing Code: 470 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 470
Insurance Median: $17,536
Cash Discount Price: $21,093
vs. Medicare Baseline: 1.25x Medicare

The contracted insurance negotiated median rate for a Hip or knee replacement (inpatient stay) at Banner Behavioral Health Hospital is $17,536. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $21,093. Compared to the federal Medicare reimbursement reference rate of $14,044.15, this hospital’s rate is 1.25x the Medicare baseline. Located in 7575 East Earll Drive, Scottsdale, AZ.

Cash / Self-Pay

$21,093

Average discount available for prompt cash payment at this facility.

Insurance Median

$17,536

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: $21,093 (150%)

Insurance Median: $17,536 (125%)

Cash: $21,093 (150% of Medicare)

Ins. Median: $17,536 (125% 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	$17,536 - $23,849	125%
Banner Health	$17,536	125%
Banner University Health Plan	$17,536	125%
Blue Cross Blue Shield	$17,536 - $45,136	125%
Health Choice Arizona, Inc.	$17,536 - $26,304	125%
Health Net	$17,536 - $25,954	125%
Kaiser Foundation Health Plan	$17,536	125%
Triwest Healthcare Alliance Corp - Va Ccn	$17,536	125%
Upmc Health Plan	$17,536	125%
Wellpoint	$17,536	125%
Carelon	$18,413	131%
Devoted Health Services	$18,413	131%
Gold Kidney Health Plan	$19,290	137%

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 $21,093.
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 Behavioral Health 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.