CMS Price Transparency Data

Hip or knee replacement (inpatient stay)

Facility: Saint Agnes Medical Center

Billing Code: 470 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 470
Insurance Median: $20,225
Cash Discount Price: $58,510
vs. Medicare Baseline: 1.44x Medicare

The contracted insurance negotiated median rate for a Hip or knee replacement (inpatient stay) at Saint Agnes Medical Center is $20,225. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $58,510. Compared to the federal Medicare reimbursement reference rate of $14,044.15, this hospital’s rate is 1.44x the Medicare baseline. Located in 1303 E Herndon Ave, Fresno, CA.

Cash / Self-Pay

$58,510

Average discount available for prompt cash payment at this facility.

Insurance Median

$20,225

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: $58,510 (417%)

Insurance Median: $20,225 (144%)

Cash: $58,510 (417% of Medicare)

Ins. Median: $20,225 (144% 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
Cba Network By Design	$4,550	32%
Network Health	$4,550	32%
Healthnet	$5,570	40%
Coventry	$6,191	44%
Advantek Central Usd	$6,621	47%
Blue Cross Blue Shield	$6,853 - $43,268	49%
Allegiance	$10,717	76%
American Postal Workers Secondary	$10,717	76%
Cigna	$10,717	76%
Medicare (plans)	$17,236 - $20,225	123%
Aetna	$19,243	137%
Humana	$19,243 - $19,636	137%
UnitedHealthcare	$19,628 - $35,739	140%
Welbe Health	$22,492	160%
Align Senior Care	$22,581	161%
Kaiser Permanente	$34,362	245%
Blue Shield - Ca	$34,922 - $43,268	249%
Geha	$35,739	254%
Blue Benefit Administrators Of Massachusetts	$43,268	308%
Blue Care Network	$43,268	308%
Blue Distinction Transplant	$43,268	308%
Blue Shield - Id (Regence)	$43,268	308%
Blue Shield - Ny Highmark Northeastern	$43,268	308%
Blue Shield - Ny Highmark Western	$43,268	308%
Blue Shield - Pa (Highmark)	$43,268	308%
Blue Shield - Wa (Regence)	$43,268	308%

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 $58,510.
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 Saint Agnes Medical Center 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.