Hip or knee replacement (inpatient stay)
Facility: Sonoma Valley Hospital
Billing Code: 470 (MS-DRG)
- CPT Billing Code: 470
- Insurance Median: $22,968
- Cash Discount Price: $154,424
- vs. Medicare Baseline: 1.64x Medicare
Average discount available for prompt cash payment at this facility.
Median negotiated contract rate across all mapped commercial carriers.
Standard federal government reimbursement rate for this code.
Visual Cost Comparison vs. 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.
Commercial Insurance Negotiated Rates
Negotiated contract ranges established by major commercial carriers at this facility.
| Carrier / Plan Group | Contract Rate Range | vs. Medicare Reference |
|---|---|---|
| Hospice Of Marin-All Plans | $1,517 | 11% |
| Ppo Alliance-All Plans | $1,620 | 12% |
| By The Bay Health Ip Only - All Plans | $1,700 | 12% |
| Comm Care Network(Ccn)-All Plans | $2,000 | 14% |
| Great West-One Health Plan Ppo/Pos-All Plans | $2,570 | 18% |
| Pacificare (Mipa)-All Plans | $4,300 | 31% |
| Partnership Healthplan-All Plans | $5,766 | 41% |
| Healthnet Hmo/Ppo-All Other Plans | $12,190 | 87% |
| St Joseph Heritage Hltcare Comm-All Other Plans | $12,229 | 87% |
| Champus-All Plans | $16,269 | 116% |
| Tricare | $18,566 | 132% |
| Blue Cross Blue Shield | $19,140 - $23,401 | 136% |
| Bright Hlth/Brand New Day Mcr Adv | $19,140 | 136% |
| Healthnet Senior | $19,140 | 136% |
| Marin General Comm/Mcr Adv (Western Hlth)-All Plans | $19,140 | 136% |
| St Joseph Heritage Hltcare Mcr Adv | $19,140 | 136% |
| UnitedHealthcare | $19,140 - $85,129 | 136% |
| Veterans Admin-All Plans | $19,140 | 136% |
| Scan Mcare-All Plans | $19,262 | 137% |
| Cdcr Prison-All Plans | $22,968 | 164% |
| Correct Care Integ Health-All Plans | $22,968 | 164% |
| Employer Direct Healthcare-All Plans | $22,968 | 164% |
| Three Rivers (Trpn)-All Plans | $22,968 | 164% |
| Chp - Correctional Health Partners - All Plans | $24,882 | 177% |
| Creative Legal Services-All Plans | $24,882 | 177% |
| Wellpath - All Plans | $26,796 | 191% |
| Bright Hlth/Brand New Day - All Other Plands | $27,753 | 198% |
| Blue Shield Ppo-All Plans | $28,789 | 205% |
| Canopy Health Solutions-All Other Plans | $29,381 | 209% |
| Vnpn - All Plans | $34,453 | 245% |
| Aetna | $38,766 | 276% |
| First Health(Coventry)-All Plans | $38,766 | 276% |
| Medi-Cal | $45,599 | 325% |
| Bps-All Plans | $46,896 | 334% |
| Pref Health Networl(Phn)-All Plans | $53,286 | 379% |
| Phcs/Multiplan/Beech St-All Plans | $55,116 | 392% |
| Interplan-All Plans | $59,674 | 425% |
| Cigna | $61,568 | 438% |
| Mcal Mgd Care (Php)-All Plans | $65,921 | 469% |
| M-Cal (Eds) Ip Only - All Plans | $91,331 | 650% |
| Kaiser-All Plans | $143,394 | 1021% |
| Integrated Health Plan-All Plans | $163,248 | 1162% |
| Networks By Design - All Plans | $176,485 | 1257% |