CMS Price Transparency Data

Hip or knee replacement (inpatient stay)

Facility: Montrose Regional Health

Billing Code: 470 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 470
Insurance Median: $89,792
Cash Discount Price: $71,264
vs. Medicare Baseline: 6.39x Medicare

The contracted insurance negotiated median rate for a Hip or knee replacement (inpatient stay) at Montrose Regional Health is $89,792. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $71,264. Compared to the federal Medicare reimbursement reference rate of $14,044.15, this hospital’s rate is 6.39x the Medicare baseline. Located in 800 S 3Rd St, Montrose, CO.

Cash / Self-Pay

$71,264

Average discount available for prompt cash payment at this facility.

Insurance Median

$89,792

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: $71,264 (507%)

Insurance Median: $89,792 (639%)

Cash: $71,264 (507% of Medicare)

Ins. Median: $89,792 (639% 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 639% of the Medicare baseline (a markup of 539%). 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
United Rocky Mountain Chp-All Other Plans	$1,498	11%
Blue Cross Blue Shield	$14,973 - $89,317	107%
Humana	$14,973 - $90,267	107%
Medicare (plans)	$14,973	107%
Montrose Community Healthplan-All Plans	$80,766	575%
Western Healthcare Alliance-All Plans	$85,517	609%
United Rocky Mountain Private Plan	$87,892	626%
Cigna	$90,267	643%
Multiplan-All Plans	$90,267	643%
Three Rivers-All Plans	$90,267	643%
Uchpa - All Plans	$90,267	643%
United Rocky Mountain Self Insured	$90,267	643%
UnitedHealthcare	$90,267	643%
Sloans Lake Managed Care-All Plans	$90,505	644%

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 $71,264.
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 Montrose Regional Health 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.