CMS Price Transparency Data

Hip or knee replacement (inpatient stay)

Facility: Memorialcare Saddleback Medical Center

Billing Code: 470 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 470
Insurance Median: $25,060
Cash Discount Price: Unavailable
vs. Medicare Baseline: 1.78x Medicare

The contracted insurance negotiated median rate for a Hip or knee replacement (inpatient stay) at Memorialcare Saddleback Medical Center is $25,060. 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 1.78x the Medicare baseline. Located in 24451 Health Center Drive, Laguna Hills, CA.

Cash / Self-Pay

Unavailable

Average discount available for prompt cash payment at this facility.

Insurance Median

$25,060

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: $25,060 (178%)

Ins. Median: $25,060 (178% 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
Scan Health Plan	$16,738	119%
Monarch Health Plan	$17,098 - $38,516	122%
Blue Shield	$17,638 - $36,812	126%
Aetna	$17,998 - $96,744	128%
Alignment Health Plan	$17,998	128%
Blue Cross Blue Shield	$17,998 - $46,263	128%
Citizens Choice	$17,998	128%
Healthnet	$17,998 - $66,113	128%
Heritage Provider Network	$17,998	128%
Humana	$17,998	128%
La Care	$17,998	128%
Onecare	$17,998	128%
Seoul Medical Group	$17,998	128%
UnitedHealthcare	$17,998 - $64,405	128%
Clever Care	$18,898	135%
Easy Choice	$18,898	135%
Select Health	$18,898 - $24,297	135%
Universal Care	$18,898	135%
Central Health	$19,798	141%
Cigna	$31,938 - $50,205	227%
Centivo	$40,495	288%

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 Memorialcare Saddleback 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.