CMS Price Transparency Data

Hip or knee replacement (inpatient stay)

Facility: Sharp Chula Vista Medical Center

Billing Code: 470 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 470
Insurance Median: $92,156
Cash Discount Price: $108,334
vs. Medicare Baseline: 6.56x Medicare

The contracted insurance negotiated median rate for a Hip or knee replacement (inpatient stay) at Sharp Chula Vista Medical Center is $92,156. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $108,334. Compared to the federal Medicare reimbursement reference rate of $14,044.15, this hospital’s rate is 6.56x the Medicare baseline. Located in 751 Medical Center Court, Chula Vista, CA.

Cash / Self-Pay

$108,334

Average discount available for prompt cash payment at this facility.

Insurance Median

$92,156

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: $108,334 (771%)

Insurance Median: $92,156 (656%)

Cash: $108,334 (771% of Medicare)

Ins. Median: $92,156 (656% 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 656% of the Medicare baseline (a markup of 556%). 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
Blue Cross Blue Shield	$42,900 - $101,112	305%
Community Health Group	$49,112	350%
San Diego Pace	$49,112	350%
Multiplan	$69,334	494%
Health Net	$86,667 - $118,445	617%
Epic Americas	$92,156	656%
UnitedHealthcare	$98,223	699%
Interplan	$108,334	771%
Aetna	$118,445	843%
Indian Health Council	$118,445	843%

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 $108,334.
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 Sharp Chula Vista 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.