Hip or knee replacement (inpatient stay)
Facility: AHMC Seton Medical Center
Billing Code: 470 (MS-DRG)
- CPT Billing Code: 470
- Insurance Median: $21,564
- Cash Discount Price: Unavailable
- vs. Medicare Baseline: 1.54x Medicare
Average discount available for prompt cash payment at this facility.
Median negotiated contract rate across all mapped commercial carriers.
Standard federal government reimbursement rate for this code.
Visual Cost Comparison vs. 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.
Commercial Insurance Negotiated Rates
Negotiated contract ranges established by major commercial carriers at this facility.
| Carrier / Plan Group | Contract Rate Range | vs. Medicare Reference |
|---|---|---|
| Healthcare Foundation Of San Mateo | $1,657 - $1,907 | 12% |
| San Mateo County/San Mateo County General Hospital | $1,802 | 13% |
| Chinese Community Health Plan | $2,578 - $21,564 | 18% |
| The First Health Network | $2,700 | 19% |
| Blue Cross Blue Shield | $4,165 - $21,564 | 30% |
| Cigna | $4,204 - $4,673 | 30% |
| Ahmc Health | $4,591 | 33% |
| Health Net | $5,003 | 36% |
| UnitedHealthcare | $12,427 - $21,969 | 88% |
| Veterans Administration (Va) | $15,378 | 109% |
| Aetna | $21,564 - $30,942 | 154% |
| Blue Shield Of California | $21,564 - $34,242 | 154% |
| Care Advantage | $21,564 | 154% |
| For Your Benefit | $21,564 | 154% |
| Healthnet Seniority | $21,564 | 154% |
| Humana | $21,564 | 154% |
| Imperial Health Plan | $21,564 | 154% |
| Jade Health Care Mg | $21,564 | 154% |
| Medicare (plans) | $21,564 | 154% |
| North East Medical Services | $21,564 | 154% |
| Pacificare | $21,564 | 154% |
| Canopy Health | $21,969 - $49,430 | 156% |
| Covid-19 Uninsured Program | $21,969 | 156% |
| Kaiser | $21,969 | 156% |
| Easy Choice Hospital Services | $22,188 | 158% |
| Brand New Day | $23,289 - $27,461 | 166% |
| Central Health Plan | $23,289 | 166% |
| Knox-Keene Act | $27,461 | 196% |
| Workers Compensation Federal | $30,508 | 217% |
| Athens Administrators | $32,569 | 232% |
| Corvel Healthcare | $32,569 | 232% |
| Multiplan/Bce Emergis | $32,569 | 232% |
| Work Comp Other | $32,569 | 232% |