CMS Price Transparency Data

Hip or knee replacement (inpatient stay)

Facility: Marinhealth Medical Center

Billing Code: 470 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 470
Insurance Median: $53,965
Cash Discount Price: Unavailable
vs. Medicare Baseline: 3.84x Medicare

The contracted insurance negotiated median rate for a Hip or knee replacement (inpatient stay) at Marinhealth Medical Center is $53,965. 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 3.84x the Medicare baseline. Located in 250 Bon Air Road, Greenbrae, CA.

Cash / Self-Pay

Unavailable

Average discount available for prompt cash payment at this facility.

Insurance Median

$53,965

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: $53,965 (384%)

Ins. Median: $53,965 (384% 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.

Elevated Commercial Rate Alert (Value-Gap)

The negotiated rate at this facility is 384% of the Medicare baseline (a markup of 284%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.

Consult Patient Advocate

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
Aetna	$3,070 - $21,277	22%
Brown And Tolan	$21,277	152%
Healthnet Tailored Network	$21,277	152%
Kaiser	$21,277	152%
Marin Cancer Care	$21,277	152%
Ca Prison Health Care Services	$34,043	242%
Healthnet Enhancedcare	$48,936	348%
UnitedHealthcare	$53,965	384%
Blue Shield Cpic/Epo	$56,107	400%
Provider Network Of America	$56,383	401%
Blue Shield Aco	$57,362	408%
Providers Network Of America	$61,702	439%
Blue Shield Hmo/Ppo	$62,341	444%
Hills Blue Shield Hmo/Ppo	$62,341	444%
Healthnet Hmo/Ppo	$65,319	465%
Healthnet Hmo/Ppo Hill Physicians	$65,319	465%

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 Marinhealth 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.