CMS Price Transparency Data

Hip or knee replacement (inpatient stay)

Facility: Calais Community Hospital

Billing Code: 470 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 470
Insurance Median: $45,224
Cash Discount Price: $42,718
vs. Medicare Baseline: 3.22x Medicare

The contracted insurance negotiated median rate for a Hip or knee replacement (inpatient stay) at Calais Community Hospital is $45,224. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $42,718. Compared to the federal Medicare reimbursement reference rate of $14,044.15, this hospital’s rate is 3.22x the Medicare baseline. Located in 24 Hospital Lane, Calais, ME.

Cash / Self-Pay

$42,718

Average discount available for prompt cash payment at this facility.

Insurance Median

$45,224

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: $42,718 (304%)

Insurance Median: $45,224 (322%)

Cash: $42,718 (304% of Medicare)

Ins. Median: $45,224 (322% 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 322% of the Medicare baseline (a markup of 222%). 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
Humana	$25,061	178%
Wellcare	$25,061	178%
Partners Direct Health	$33,035	235%
Blue Cross Blue Shield	$45,224	322%
Cigna	$47,901	341%
Aetna	$48,983	349%
UnitedHealthcare	$48,983	349%
Martins Point	$51,261	365%
Harvard Pilgrim	$52,116	371%

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 $42,718.
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 Calais Community 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.