CMS Price Transparency Data

Hip or knee replacement (inpatient stay)

Facility: Providence Queen of the Valley Medical Center

Billing Code: 470 (MS-DRG)

Factual Cost Summary (Answer Capsule)
  • CPT Billing Code: 470
  • Insurance Median: $21,616
  • Cash Discount Price: Unavailable
  • vs. Medicare Baseline: 1.54x Medicare
The contracted insurance negotiated median rate for a Hip or knee replacement (inpatient stay) at Providence Queen of the Valley Medical Center is $21,616. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is unavailable. Compared to the federal Medicare reimbursement reference rate of $14,044.15, this hospital’s rate is 1.54x the Medicare baseline. Located in 1000 Trancas St, Napa, CA.
Cash / Self-Pay
Unavailable

Average discount available for prompt cash payment at this facility.

Insurance Median
$21,616

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%)
Insurance Median: $21,616 (154%)
Ins. Median: $21,616 (154% 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.

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
Cigna $18,779 - $21,616 134%
Aetna $21,616 - $85,449 154%
Blue Cross Blue Shield $21,616 154%
Blue Shield $21,616 - $44,199 154%
Devoted Health $21,616 154%
Healthnet $21,616 - $38,146 154%
Humana $21,616 154%
Kaiser $21,616 154%
Molina Healthcare $21,616 154%
Providence Health Plan $21,616 154%
UnitedHealthcare $21,616 - $60,255 154%
Western Health Advantage $21,616 154%

Self-Pay Upfront Cash Action Plan

Insurance In-Network Protection Plan

Facility Profile & Credentials

  • Address: 1000 Trancas St, Napa, CA 94558
  • CMS Rating: ★★★★☆
  • Ownership Type: Voluntary non-profit - Private
  • Hospital Type: Acute Care Hospitals