CMS Price Transparency Data

Hip or knee replacement (inpatient stay)

Facility: Alhambra Hospital Medical Center

Billing Code: 470 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 470
Insurance Median: $20,398
Cash Discount Price: Unavailable
vs. Medicare Baseline: 1.45x Medicare

The contracted insurance negotiated median rate for a Hip or knee replacement (inpatient stay) at Alhambra Hospital Medical Center is $20,398. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is unavailable. Compared to the federal Medicare reimbursement reference rate of $14,044.15, this hospital’s rate is 1.45x the Medicare baseline. Located in 100 S Raymond Ave, Alhambra, CA.

Cash / Self-Pay

Unavailable

Average discount available for prompt cash payment at this facility.

Insurance Median

$20,398

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%)

Insurance Median: $20,398 (145%)

Ins. Median: $20,398 (145% 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
Medicare (plans)	$1,700 - $22,436	12%
Citrus Valley Health Partners	$1,751	12%
Ahmc-Reciprocity-Medi-Cal/Healthy Families	$1,937	14%
Allied Physicians Comm/Sr	$2,350	17%
Health Net Exchange Enhanced Ppo	$2,653	19%
Blue Cross Blue Shield	$3,204 - $20,975	23%
Ahmc Health	$3,950	28%
Blue Shield Value Network Exchange	$3,972	28%
Cigna	$4,200 - $6,496	30%
Blue Shield Hmo/Ppo	$4,429	32%
Aetna	$5,766 - $21,368	41%
Ahmc-Reciprocity-Comm/Senior	$6,556	47%
Blue Shield 65 Plus	$20,136	143%
Apa Aco	$20,660	147%
Humana	$20,940	149%
Altamed Senior Services	$20,975	149%
Brand New Day Sr	$20,975	149%
Central Health Plan Of Ca Senior Hmo	$20,975	149%
Health Net Senior Hmo	$20,975	149%
La Care Exchange	$21,368	152%
Miscellaneous Senior Hmo	$21,368	152%
UnitedHealthcare	$21,368	152%
Wellcare Senior Hmo	$21,368	152%
Alignment Senior Hmo	$22,024	157%
Health Net Exchange	$24,124	172%
Health Net Salud Con Hmo	$24,124	172%
Health Net Ppo/Epo/Pos	$26,090	186%
Molina Exchange	$26,219	187%
Miscellaneous Work Comp Hmo	$35,713	254%

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 $X.
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 Alhambra Hospital 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.