CMS Price Transparency Data

Hip or knee replacement (inpatient stay)

Facility: Shands Jacksonville

Billing Code: 470 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 470
Insurance Median: $25,171
Cash Discount Price: Unavailable
vs. Medicare Baseline: 1.79x Medicare

The contracted insurance negotiated median rate for a Hip or knee replacement (inpatient stay) at Shands Jacksonville is $25,171. 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 1.79x the Medicare baseline. Located in 655 W 8Th St, Jacksonville, FL.

Cash / Self-Pay

Unavailable

Average discount available for prompt cash payment at this facility.

Insurance Median

$25,171

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: $25,171 (179%)

Ins. Median: $25,171 (179% 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
Capital Health Plan	$8,258	59%
Health First Health Plan	$10,513 - $10,995	75%
Blue Cross Blue Shield	$16,742 - $36,404	119%
Aetna	$19,882 - $22,774	142%
Avmed	$22,829 - $25,890	163%
Ameri-Plus Preferred Care	$23,973	171%
Humana	$23,973 - $24,212	171%
Beacon Health Strategies	$24,692	176%
Careplus Health Plan	$24,692	176%
Florida Health Care Plan	$24,692 - $30,670	176%
UnitedHealthcare	$24,932	178%
Devoted Health Plan	$25,171 - $26,370	179%
Florida Complete Care	$26,370	188%
Positive Healthcare Partners	$26,370	188%
Truli For Health	$27,750	198%
Wellcare Of Florida	$28,048	200%
Cigna	$28,085	200%
Molina	$28,875	206%
Volusia Health Network	$35,538	253%
Wellpath	$35,538	253%
Ambetter / Centene	$36,871	263%

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 Shands Jacksonville 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.