CMS Price Transparency Data

Hip or knee replacement (inpatient stay)

Facility: Banner Fort Collins Medical Center

Billing Code: 470 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 470
Insurance Median: $16,507
Cash Discount Price: $21,385
vs. Medicare Baseline: 1.18x Medicare

The contracted insurance negotiated median rate for a Hip or knee replacement (inpatient stay) at Banner Fort Collins Medical Center is $16,507. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $21,385. Compared to the federal Medicare reimbursement reference rate of $14,044.15, this hospital’s rate is 1.18x the Medicare baseline. Located in 4700 Lady Moon Dr, Fort Collins, CO.

Cash / Self-Pay

$21,385

Average discount available for prompt cash payment at this facility.

Insurance Median

$16,507

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: $21,385 (152%)

Insurance Median: $16,507 (118%)

Cash: $21,385 (152% of Medicare)

Ins. Median: $16,507 (118% 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
Pinnacol Assurance Workers Comp	$13,528	96%
UnitedHealthcare	$15,545 - $66,179	111%
Banner Health	$16,026	114%
Blue Cross Blue Shield	$16,026	114%
Cigna	$16,026	114%
Clear Spring Health	$16,026	114%
Healthspring Life & Health Insurance Company, Inc.	$16,026	114%
Medica	$16,026	114%
Medicare (plans)	$16,026	114%
Humana	$16,507	118%
Longevity	$16,507	118%
Devoted Health Services	$16,828	120%
Assist Health Group	$19,231	137%
Denver Health Medical Plan	$28,644	204%
Centivo	$36,059	257%
Decent Health	$36,296	258%
Hue Health, Inc	$40,867	291%
Aetna	$68,659	489%

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 $21,385.
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 Banner Fort Collins 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.