CMS Price Transparency Data

Hip or knee replacement (inpatient stay)

Facility: Grossmont Hospital

Billing Code: 470 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 470
Insurance Median: $97,501
Cash Discount Price: $108,334
vs. Medicare Baseline: 6.94x Medicare

The contracted insurance negotiated median rate for a Hip or knee replacement (inpatient stay) at Grossmont Hospital is $97,501. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $108,334. Compared to the federal Medicare reimbursement reference rate of $14,044.15, this hospital’s rate is 6.94x the Medicare baseline. Located in 5555 Grossmont Center Drive Box 58, La Mesa, CA.

Cash / Self-Pay

$108,334

Average discount available for prompt cash payment at this facility.

Insurance Median

$97,501

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: $108,334 (771%)

Insurance Median: $97,501 (694%)

Cash: $108,334 (771% of Medicare)

Ins. Median: $97,501 (694% 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.

Elevated Commercial Rate Alert (Value-Gap)

The negotiated rate at this facility is 694% of the Medicare baseline (a markup of 594%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.

Consult Patient Advocate

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
Health Net	$43,334 - $118,445	309%
Blue Shield	$69,204	493%
Epic Americas	$69,204	493%
Molina	$91,001	648%
Aetna	$92,156	656%
Humana	$98,223	699%
Indian Health Council	$101,112	720%
San Diego Pace	$115,556	823%
Allianz Global Assistance	$141,557	1008%

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 $108,334.
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 Grossmont 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.