CMS Price Transparency Data

Hip or knee replacement (inpatient stay)

Facility: Adventist Health and Rideout

Billing Code: 470 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 470
Insurance Median: $102,777
Cash Discount Price: $31,982
vs. Medicare Baseline: 7.32x Medicare

The contracted insurance negotiated median rate for a Hip or knee replacement (inpatient stay) at Adventist Health and Rideout is $102,777. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $31,982. Compared to the federal Medicare reimbursement reference rate of $14,044.15, this hospital’s rate is 7.32x the Medicare baseline. Located in 726 4Th St, Marysville, CA.

Cash / Self-Pay

$31,982

Average discount available for prompt cash payment at this facility.

Insurance Median

$102,777

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: $31,982 (228%)

Insurance Median: $102,777 (732%)

Cash: $31,982 (228% of Medicare)

Ins. Median: $102,777 (732% 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 732% of the Medicare baseline (a markup of 632%). 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
Healthnet Mcal	$4,422	31%
Kaiser Mcr Adv	$18,531	132%
Tricare	$18,531	132%
UnitedHealthcare	$18,531 - $126,269	132%
Blue Cross Blue Shield	$18,716 - $107,429	133%
Celtic Mcaid-All Plans	$28,204	201%
Ca Health And Wellness- All Plans	$28,590	204%
Bc Mcal	$33,276	237%
Ah Employee Health Plan - All Plans	$33,356	238%
Partnership Hp Mcal -All Plans	$34,078	243%
Kaiser Mcal	$37,753	269%
Medi-Cal	$37,753	269%
Aetna	$102,777	732%
Kaiser-All Other Plans	$110,482	787%
Healthnet Comm-All Other Plans	$111,063	791%
Blue Shield Uc Care Members	$116,296	828%
Cigna	$125,120	891%
First Health-All Plans	$127,199	906%
Interplan-All Plans	$130,833	932%
Phcs-All Plans	$130,833	932%
Blue Shield-All Other Plans	$138,102	983%
Multiplan-All Plans	$138,102	983%

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 $31,982.
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 Adventist Health and Rideout 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.