CMS Price Transparency Data

Hip or knee replacement (inpatient stay)

Facility: San Dimas Community Hospital

Billing Code: 470 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 470
Insurance Median: $18,312
Cash Discount Price: $18,311
vs. Medicare Baseline: 1.30x Medicare

The contracted insurance negotiated median rate for a Hip or knee replacement (inpatient stay) at San Dimas Community Hospital is $18,312. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $18,311. Compared to the federal Medicare reimbursement reference rate of $14,044.15, this hospital’s rate is 1.30x the Medicare baseline. Located in 1350 W Covina Blvd, San Dimas, CA.

Cash / Self-Pay

$18,311

Average discount available for prompt cash payment at this facility.

Insurance Median

$18,312

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: $18,311 (130%)

Insurance Median: $18,312 (130%)

Cash: $18,311 (130% of Medicare)

Ins. Median: $18,312 (130% 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
Blue Cross Blue Shield	$18,043 - $30,723	128%
Blue Shield Of Ca	$18,043 - $22,196	128%
Central Health Plan	$18,043	128%
Choice Physicians Network	$18,043	128%
Elite Health Plan	$18,043	128%
Health Excel Inc	$18,043	128%
Health Net Of Ca	$18,043 - $33,181	128%
Heritage Provider Network Inc	$18,043 - $23,805	128%
La Care Health Plan	$18,043 - $18,312	128%
Molina Healthcare	$18,043 - $18,312	128%
Patient Choice Health Plan	$18,043	128%
Renal Payer Solutions	$18,043	128%
UnitedHealthcare	$18,043 - $23,805	128%
Brand New Day	$18,224 - $22,219	130%
Medicare (plans)	$18,312	130%
Aids Healthcare Foundation	$18,404	131%
Imperial Health Plan Inc	$19,126	136%
Employer Direct Healthcare	$23,805	170%
Tricare	$25,536	182%
Primecare Medical Network	$27,468	196%
Aetna	$28,134	200%
Ca Foundation For Medical Care	$28,424	202%
Worker Comp	$29,004	207%
National Healthcare Solutions, Inc (Nhsi)	$29,299	209%

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 $18,311.
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 San Dimas Community Hospital 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.