CMS Price Transparency Data
Hip or knee replacement (inpatient stay)
Facility: San Antonio Regional Hospital
Billing Code: 470 (MS-DRG)
Factual Cost Summary (Answer Capsule)
- CPT Billing Code: 470
- Insurance Median: $19,513
- Cash Discount Price: $103,935
- vs. Medicare Baseline: 1.39x Medicare
The contracted insurance negotiated median rate for a Hip or knee replacement (inpatient stay) at San Antonio Regional Hospital is $19,513. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $103,935. Compared to the federal Medicare reimbursement reference rate of $14,044.15, this hospital’s rate is 1.39x the Medicare baseline. Located in 999 San Bernardino Road, Upland, CA.
Cash / Self-Pay
$103,935
Average discount available for prompt cash payment at this facility.
Insurance Median
$19,513
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: $103,935 (740%)
Insurance Median: $19,513 (139%)
Cash: $103,935 (740% of Medicare)
Ins. Median: $19,513 (139% 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
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Commercial Insurance Negotiated Rates
Negotiated contract ranges established by major commercial carriers at this facility.
| Carrier / Plan Group | Contract Rate Range | vs. Medicare Reference |
|---|---|---|
| San Bernardino Cnty Ip Only-All Plans | $3,000 | 21% |
| Foundation Inland Ppo | $5,133 | 37% |
| Medi-Cal | $12,961 | 92% |
| Kaiser Medi-Cal | $13,609 | 97% |
| Healthnet Medi-Cal | $13,674 | 97% |
| Molina Medi-Cal | $14,128 | 101% |
| Alpha Care Mg Mcal/Hlthy Kids | $14,258 | 102% |
| Heritage Prov Ntwrk/Regal Mcal | $14,258 | 102% |
| Pc Inland Valley Scan | $14,525 | 103% |
| Pc Inland Valley-All Other Plans | $14,525 | 103% |
| Iehp Mcal | $15,035 | 107% |
| Blue Cross Blue Shield | $15,294 - $33,528 | 109% |
| UnitedHealthcare | $16,092 - $52,031 | 115% |
| Tricare | $18,748 | 133% |
| Aetna | $19,130 - $25,826 | 136% |
| Alpha Care Mg Mcr Adv | $19,130 | 136% |
| Blue Shield Mcr Adv | $19,130 | 136% |
| Caremore Mcr Adv - All Plans | $19,130 | 136% |
| Central Hlth Plan Mcr Adv-All Plans | $19,130 | 136% |
| Choice Phycn Ntwrk Mcr Adv-All Other Plans | $19,130 | 136% |
| Epic Health Plan Mcr Adv | $19,130 | 136% |
| Healthnet Mcr Adv | $19,130 | 136% |
| Humana | $19,130 | 136% |
| Iehp Mcr Adv | $19,130 | 136% |
| Imperial Health Mcr Adv-All Plans | $19,130 | 136% |
| Inter Valley Hp Mcr Adv- All Plans | $19,130 | 136% |
| Kindred Mcr Adv-All Plans | $19,130 | 136% |
| Molina Mcr Adv | $19,130 | 136% |
| Prospect Hp-All Plans | $19,130 | 136% |
| Providence Clevercare Mcr Adv | $19,130 | 136% |
| Scan Health Plan Mcr Adv-All Plans | $19,130 | 136% |
| Universal Care - All Plans | $19,130 | 136% |
| Heritage Prov Ntwrk/Regal Mcr Adv | $19,417 | 138% |
| Wellcare/Easy Choice-All Plans | $19,513 | 139% |
| Foundation Inland Epo-All Other Plans | $20,072 | 143% |
| Clever Care Mcr Adv - All Plans | $20,087 | 143% |
| La Salle Hp Mcr Adv-All Plans | $20,087 | 143% |
| Zelis Mcr Adv | $20,087 | 143% |
| Kasiser Mcr Adv | $20,469 | 146% |
| Heritage Prov Ntwrk/Regal - All Other Plans | $22,305 | 159% |
| Blue Shield Epn | $22,464 | 160% |
| Alpha Care Mg-All Other Plans | $23,913 | 170% |
| Choicecare Ntwrk-All Plans | $24,491 | 174% |
| Molina Exchange-All Other Plans | $24,869 | 177% |
| Iehp Comm - All Other Plans | $27,739 | 198% |
| Providence Oscar-All Other Plans | $27,739 | 198% |
| Redlands Employee | $28,695 | 204% |
| Redlands Hmo-All Other Plans | $29,843 | 212% |
| Healthnet - All Other Plans | $30,054 | 214% |
| Epic Health Plan - All Other Plans | $30,569 | 218% |
| Coventry Ccn/First Hlth - All Plans | $32,167 | 229% |
| Prime Health - All Plans | $33,478 | 238% |
| Ambetter / Centene | $33,841 | 241% |
| Cigna | $40,391 | 288% |
| Blue Shield Hmo Pos / Calpers Ppo | $43,092 | 307% |
| Blue Shield Epo Ppo - All Other Plans | $44,212 | 315% |
| Kaiser Comm - All Other Plans | $53,373 | 380% |
| Networks By Design - All Plans | $57,034 | 406% |
| Multiplan/Phcs - All Plans | $74,833 | 533% |
| Zelis Comm-All Other Plans | $76,423 | 544% |
| Interplan - All Plans | $81,518 | 580% |
| Health Payors - All Plans | $86,613 | 617% |