Hip or knee replacement (inpatient stay)
Facility: North Shore Medical Center
Billing Code: 470 (MS-DRG)
- CPT Billing Code: 470
- Insurance Median: $16,986
- Cash Discount Price: Unavailable
- vs. Medicare Baseline: 1.21x Medicare
Average discount available for prompt cash payment at this facility.
Median negotiated contract rate across all mapped commercial carriers.
Standard federal government reimbursement rate for this code.
Visual Cost Comparison vs. 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.
Commercial Insurance Negotiated Rates
Negotiated contract ranges established by major commercial carriers at this facility.
| Carrier / Plan Group | Contract Rate Range | vs. Medicare Reference |
|---|---|---|
| Aetna | $2,169 - $16,177 | 15% |
| Dimension Health Wc | $2,283 | 16% |
| Workers Compensation | $2,283 | 16% |
| Humana | $4,098 - $15,853 | 29% |
| Veterans Administration Mill Bill | $11,324 | 81% |
| Medicare (plans) | $15,368 - $35,416 | 109% |
| Leon Health Inc | $16,143 | 115% |
| Devoted Health | $16,177 | 115% |
| UnitedHealthcare | $16,177 - $40,246 | 115% |
| Veterans Administration Vaccn | $16,473 | 117% |
| Cigna | $16,986 - $23,569 | 121% |
| Florida Pace Centers | $16,986 | 121% |
| Healthsun Health Plans | $16,986 | 121% |
| Longevity Health Plan | $17,296 | 123% |
| Oscar Health Plan Hix | $18,207 | 130% |
| Tricare | $19,321 | 138% |
| Bright Health Management Commercial | $19,767 | 141% |
| Centurion Prison | $20,221 | 144% |
| Self Pay/Uninsured | $20,221 | 144% |
| Molina Marketplace Program Exchange | $20,346 | 145% |
| Employer Direct Healthcare | $22,077 | 157% |
| Avmed Broad Network | $23,742 | 169% |
| Bc/Bs Myblue Hmo Hix | $23,805 | 170% |
| Bc/Bs Of Fl Health Options Hmo | $23,805 | 170% |
| Bc/Bs Of Fl Simplyblue | $23,805 | 170% |
| Imagine Health | $26,361 | 188% |
| Avmed Exchange | $28,827 | 205% |
| Ambetter / Centene | $30,474 | 217% |
| Bc/Bs Of Fl Network Blue | $32,342 | 230% |
| Auto Insurance | $32,945 | 235% |
| Avmed Select Network | $33,647 | 240% |
| Amerihealth Caritas Next Exchange | $35,416 | 252% |
| Bc/Bs Of Fl Blue Select Exchange Non Par | $35,575 | 253% |
| Bc/Bs Of Fl Phs | $44,633 | 318% |
| Bc/Bs Of Fl Ppo | $44,633 | 318% |