Hip or knee replacement (inpatient stay)
Facility: Adventist Health Sonora
Billing Code: 470 (MS-DRG)
- CPT Billing Code: 470
- Insurance Median: $52,248
- Cash Discount Price: $32,848
- vs. Medicare Baseline: 3.72x 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.
Elevated Commercial Rate Alert (Value-Gap)
The negotiated rate at this facility is 372% of the Medicare baseline (a markup of 272%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.
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 |
|---|---|---|
| Aetna | $18,932 - $64,963 | 135% |
| Blue Shield Mcare | $18,932 | 135% |
| Healthnet Mcr Adv | $18,932 | 135% |
| Phs Prime Health Srvcs-All Plans | $18,932 | 135% |
| Tricare | $18,932 | 135% |
| UnitedHealthcare | $18,932 - $134,795 | 135% |
| Blue Shield Epn | $25,843 | 184% |
| Blue Shield - All Other Plans | $26,432 | 188% |
| Ah Employee Health Plan - All Plans | $34,078 | 243% |
| Medi-Cal | $35,264 | 251% |
| Bc Exchange | $38,892 | 277% |
| Bc Mcal | $39,882 | 284% |
| Central Ca Alliance Ccs Mcal | $39,959 | 285% |
| Central Ca Alliance Chdp Mcal | $39,959 | 285% |
| Central Ca Alliance Mcal | $39,959 | 285% |
| Celtic Ca Hlth Well Mcal - All Plans | $41,976 | 299% |
| Bc Non-Mcs - All Other Plans | $43,536 | 310% |
| Healthnet Mcal | $45,156 | 322% |
| Bc Mcs | $52,248 | 372% |
| Western Growers/Pinnacle - All Plans | $78,458 | 559% |
| Kaiser - All Plans | $96,613 | 688% |
| Interplan - All Plans | $104,308 | 743% |
| Greatwest Oa/Pos/Hmo | $144,920 | 1032% |
| Healthnet - All Other Plans | $150,330 | 1070% |
| Affordable Health - All Plans | $154,581 | 1101% |
| Greatwest Ppo - All Other Plans | $154,581 | 1101% |
| Phcs Ppo - All Plans | $154,581 | 1101% |
| Trpn - Three Rivers Ppo - All Plans | $154,581 | 1101% |
| Beech Street- All Plans | $164,242 | 1169% |
| Cigna | $164,242 | 1169% |
| Stanilaus Foundation - All Plans | $164,242 | 1169% |
| Multiplan - All Plans | $173,904 | 1238% |