CMS Price Transparency Data
Hip or knee replacement (inpatient stay)
Facility: Scripps Mercy Hospital
Billing Code: 470 (MS-DRG)
Factual Cost Summary (Answer Capsule)
- CPT Billing Code: 470
- Insurance Median: $20,709
- Cash Discount Price: $46,570
- vs. Medicare Baseline: 1.47x Medicare
The contracted insurance negotiated median rate for a Hip or knee replacement (inpatient stay) at Scripps Mercy Hospital is $20,709. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $46,570. Compared to the federal Medicare reimbursement reference rate of $14,044.15, this hospital’s rate is 1.47x the Medicare baseline. Located in 4077 5Th Ave, San Diego, CA.
Cash / Self-Pay
$46,570
Average discount available for prompt cash payment at this facility.
Insurance Median
$20,709
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: $46,570 (332%)
Insurance Median: $20,709 (147%)
Cash: $46,570 (332% of Medicare)
Ins. Median: $20,709 (147% 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 |
|---|---|---|
| Blue Cross Blue Shield | $16,164 - $52,946 | 115% |
| Aetna | $20,709 - $22,430 | 147% |
| Alignment Health Plan [443] | $20,709 | 147% |
| Astiva Mcr Adv [464] | $20,709 | 147% |
| Bc Mcr Adv [830] | $20,709 | 147% |
| Bs Mcr Adv [829] | $20,709 | 147% |
| Central Health Mcr Adv [441] | $20,709 | 147% |
| Cigna | $20,709 - $36,501 | 147% |
| Clever Care Mcr Adv [465] | $20,709 | 147% |
| D-Snp Mcr Adv [889] | $20,709 | 147% |
| Dsnp/Csnp - Generic [458] | $20,709 | 147% |
| Family Health Centers Pace Mcr Adv Hmo [556] | $20,709 | 147% |
| Family Health Centers Pace Medi-Cal [555] | $20,709 | 147% |
| Gary And Mary West Pace Medi-Cal Hmo [557] | $20,709 | 147% |
| Gpmg/Altura - Mcr Adv [888] | $20,709 | 147% |
| Hn Mcr Adv [832] | $20,709 | 147% |
| Humana | $20,709 | 147% |
| Integrated Health Partners - Mcr Adv [895] | $20,709 | 147% |
| Kaiser Northern Ca Region Mcr Adv [386] | $20,709 | 147% |
| La Care Mcr Adv Hmo [612] | $20,709 | 147% |
| Mc Alignment [917] | $20,709 | 147% |
| Mc Blue Shield Promise Health Plan [914] | $20,709 | 147% |
| Mc Blue Shield [902] | $20,709 | 147% |
| Mc Health Net [904] | $20,709 | 147% |
| Mc Scan [905] | $20,709 | 147% |
| Mc United [906] | $20,709 | 147% |
| Medicare (plans) | $20,709 | 147% |
| San Diego Pace Medi-Cal [553] | $20,709 | 147% |
| Scan Mcr Adv [835] | $20,709 | 147% |
| Scan [500] | $20,709 | 147% |
| Scan [818] | $20,709 | 147% |
| Sharp Comm Med Grp Mcr Adv [840] | $20,709 | 147% |
| Sharp Health Plan Mcr Adv [531] | $20,709 | 147% |
| Sharp Health Plan Mcr Adv [897] | $20,709 | 147% |
| Sharp Rees Stealy Med Grp Mcr Adv [841] | $20,709 | 147% |
| St Paul'S Pace Medi-Cal [551] | $20,709 | 147% |
| Ucsd Mcr Adv [873] | $20,709 | 147% |
| Uh Mcr Adv [831] | $20,709 | 147% |
| Uh Palomar Health Mcr Adv [885] | $20,709 | 147% |
| UnitedHealthcare | $20,709 - $30,587 | 147% |
| Health Net [340] | $22,202 - $44,262 | 158% |
| Mpmg Mcr Adv [836] | $22,202 | 158% |
| Mpmg [800] | $22,202 | 158% |
| Ocn Mcr Adv [890] | $22,202 | 158% |
| Prime Healthcare [614] | $22,202 | 158% |
| Prospect Med Group [893] | $22,202 | 158% |
| Palomar Health [892] | $22,430 | 160% |
| Sharp Comm Med Grp [812] | $22,430 - $44,262 | 160% |
| Sharp Rees Stealy Med Grp [811] | $22,430 - $44,262 | 160% |
| Ucsd [807] | $22,430 - $44,262 | 160% |
| Veba Med Grp [813] | $22,430 | 160% |
| Centivo [581] | $27,005 | 192% |
| Bc [814] | $27,601 | 197% |
| Imperial County Phys Med Group [855] | $27,601 | 197% |
| Integrated Health Partners [894] | $27,601 | 197% |
| Perlman Med Group [899] | $27,601 | 197% |
| Uh [819] | $30,587 | 218% |
| Hn [815] | $44,262 | 315% |