CMS Price Transparency Data

Hip or knee replacement (inpatient stay)

Facility: Gunnison Valley Hospital

Billing Code: 470 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 470
Insurance Median: $59,191
Cash Discount Price: $56,639
vs. Medicare Baseline: 4.21x Medicare

The contracted insurance negotiated median rate for a Hip or knee replacement (inpatient stay) at Gunnison Valley Hospital is $59,191. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $56,639. Compared to the federal Medicare reimbursement reference rate of $14,044.15, this hospital’s rate is 4.21x the Medicare baseline. Located in 711 N Taylor St, Gunnison, CO.

Cash / Self-Pay

$56,639

Average discount available for prompt cash payment at this facility.

Insurance Median

$59,191

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: $56,639 (403%)

Insurance Median: $59,191 (421%)

Cash: $56,639 (403% of Medicare)

Ins. Median: $59,191 (421% 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 421% of the Medicare baseline (a markup of 321%). 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
Medicare (plans)	$8,354	59%
Ebms Hdhp	$39,981	285%
U Of Co Transplant-All Plans	$39,981	285%
Ebms Ppo Plan-All Other Plans	$46,644	332%
Gunnison County Employees-All Other Plans	$53,307	380%
Scottish Rites-All Plans	$53,307	380%
Elap Employers-All Plans	$56,639	403%
Blue Cross Blue Shield	$58,412	416%
Apostrophe-All Plans	$59,971	427%
Multiplan-All Plans	$63,303	451%
Rocky Mountain Health-All Plans	$63,303	451%
UnitedHealthcare	$63,303	451%
Aetna	$63,969	455%
Cofinity-All Plans	$63,969	455%
Cigna	$65,302	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 $56,639.
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 Gunnison Valley 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.