Hip or knee replacement (inpatient stay)
Facility: Saint Joseph Regional Medical Center
Billing Code: 470 (MS-DRG)
- CPT Billing Code: 470
- Insurance Median: $30,315
- Cash Discount Price: $48,297
- vs. Medicare Baseline: 2.16x 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.
Elevated Commercial Rate Alert (Value-Gap)
The negotiated rate at this facility is 216% of the Medicare baseline (a markup of 116%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.
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 |
|---|---|---|
| UnitedHealthcare | $13,944 - $19,088 | 99% |
| Aetna | $15,636 - $26,493 | 111% |
| Blue Cross Blue Shield | $15,636 - $38,989 | 111% |
| Medicare (plans) | $15,955 - $16,274 | 114% |
| Meridian Complete | $15,955 | 114% |
| Pace-Trinity Health | $15,955 | 114% |
| County Coroner | $16,593 | 118% |
| Plain Church Group | $16,875 | 120% |
| Provider Partners Health Plan Of Indiana | $17,551 | 125% |
| Geha | $19,088 | 136% |
| Healthscope | $19,088 | 136% |
| Student Insurance Cma | $19,088 | 136% |
| Auxiant | $23,933 - $34,303 | 170% |
| Physicians Health Plan Northern Indiana Health Insurance | $23,933 - $47,386 | 170% |
| St Joseph County Hlth Dpt | $23,933 | 170% |
| Caresource | $24,730 | 176% |
| Siho Insurance Services | $25,528 | 182% |
| Key Benefit Administrator | $28,719 - $34,303 | 204% |
| Allied Benefit Systems | $30,315 | 216% |
| Custom Design Benefits | $34,303 | 244% |
| Blue Benefit Administrators Of Massachusetts | $38,989 | 278% |
| Blue Care Network | $38,989 | 278% |
| Blue Distinction Transplant | $38,989 | 278% |
| Blue Shield - Ca | $38,989 | 278% |
| Blue Shield - Id (Regence) | $38,989 | 278% |
| Blue Shield - Ny Highmark Northeastern | $38,989 | 278% |
| Blue Shield - Ny Highmark Western | $38,989 | 278% |
| Blue Shield - Pa (Highmark) | $38,989 | 278% |
| Blue Shield - Wa (Regence) | $38,989 | 278% |
| Cigna | $52,842 | 376% |
| Group Administrators | $52,842 | 376% |
| Health Partners | $52,842 | 376% |
| Mvp | $52,842 | 376% |
| Prairie States | $52,842 | 376% |
| Priority Health | $52,842 | 376% |
| Professional Benefit Administrators | $52,842 | 376% |
| Sagamore Health Network | $52,842 - $62,182 | 376% |
| Sisco Benefits | $52,842 | 376% |
| Unified Group Services | $52,842 | 376% |