CMS Price Transparency Data

Hip or knee replacement (inpatient stay)

Facility: Adventist Health Lodi Memorial

Billing Code: 470 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 470
Insurance Median: $21,800
Cash Discount Price: $10,075
vs. Medicare Baseline: 1.55x Medicare

The contracted insurance negotiated median rate for a Hip or knee replacement (inpatient stay) at Adventist Health Lodi Memorial is $21,800. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $10,075. Compared to the federal Medicare reimbursement reference rate of $14,044.15, this hospital’s rate is 1.55x the Medicare baseline. Located in 975 S Fairmont Avenue, Lodi, CA.

Cash / Self-Pay

$10,075

Average discount available for prompt cash payment at this facility.

Insurance Median

$21,800

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: $10,075 (72%)

Insurance Median: $21,800 (155%)

Cash: $10,075 (72% of Medicare)

Ins. Median: $21,800 (155% 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
Healthnet Mcal	$2,143	15%
Celtic Ins Company - All Plans	$4,308	31%
UnitedHealthcare	$11,829 - $31,714	84%
Alignment Health Plan (Ahp)-All Plans	$19,159	136%
Blue Shield Mcare Adv	$19,159	136%
Healthnet Mcare	$19,159	136%
Hp Of San Joaquin Mcr Adv	$19,159	136%
Humana	$19,159	136%
Kaiser Mcr Adv	$19,159	136%
Tricare	$19,159	136%
Cca Health Plan Mcr Adv- All Plans	$19,542	139%
Blue Cross Blue Shield	$19,594 - $21,859	140%
Kaiser Mcal	$20,912	149%
Medi-Cal	$20,912	149%
Knnex Health - All Plans	$21,800	155%
Hp Of San Joaquin Mcal	$23,215	165%
Healthnet- All Other Plans	$24,196	172%
Bc Mcal	$24,654	176%
Networks By Design- All Plans	$28,805	205%
Ah Employee Health Plan - All Plans	$34,486	246%
Bright Health - All Plans	$34,817	248%
Aetna	$39,389	280%
Blue Shield Epn - All Other Plans	$41,163	293%
Blue Shield Non-Epn	$42,602	303%
Kaiser Commercial - All Other Plans	$59,009	420%
First Health- All Plans	$107,944	769%
Multiplan- All Plans	$115,140	820%
Beech Street- All Plans	$129,532	922%
Three Rivers Provider Network- All Plans	$129,532	922%

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 $10,075.
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 Lodi Memorial 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.