Hip or knee replacement (inpatient stay)
Facility: UCI Health-Orange
Billing Code: 470 (MS-DRG)
- CPT Billing Code: 470
- Insurance Median: $28,861
- Cash Discount Price: Unavailable
- vs. Medicare Baseline: 2.06x 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 206% of the Medicare baseline (a markup of 106%). 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 | $28,296 - $84,293 | 201% |
| Alignment Health Plan | $28,296 | 201% |
| Allied Pacific Of California | $28,296 | 201% |
| Alpha Care Medical Group | $28,296 | 201% |
| Amvi/Prospect Medical Group | $28,296 | 201% |
| Blue Cross Blue Shield | $28,296 - $81,168 | 201% |
| Brand New Day | $28,296 | 201% |
| Bright Health Physicians Of Pih | $28,296 - $36,784 | 201% |
| Caloptima | $28,296 | 201% |
| Caremore | $28,296 | 201% |
| Family Choice Medical Group | $28,296 - $36,784 | 201% |
| Greater Newport Physicians Medical Group | $28,296 | 201% |
| Healthcare Partners | $28,296 | 201% |
| Hemet Community Medical Group | $28,296 | 201% |
| Heritage Provider Network | $28,296 - $41,029 | 201% |
| Humana | $28,296 | 201% |
| Memorialcare Medical Foundation | $28,296 | 201% |
| Orange County Advantage Medical Group | $28,296 | 201% |
| Prospect Medical Group | $28,296 | 201% |
| Redlands Community Hospital | $28,296 | 201% |
| Scan Health Plan | $28,296 - $45,273 | 201% |
| St. Joseph | $28,296 | 201% |
| St. Mary Choice Medical Group | $28,296 | 201% |
| UnitedHealthcare | $28,296 - $215,960 | 201% |
| Health Net | $28,861 - $121,328 | 206% |
| Blue Shield | $29,710 - $63,736 | 212% |
| Premier Health | $31,125 | 222% |
| Primecare Medical Network | $31,125 - $43,858 | 222% |
| Kaiser | $32,540 - $73,569 | 232% |
| Seaside Health Plan | $38,199 | 272% |
| Ahmc | $42,443 | 302% |
| Oscar Health Plan | $48,102 | 343% |
| Cigna | $92,429 - $115,537 | 658% |