CMS Price Transparency Data

Hip or knee replacement (inpatient stay)

Facility: Up Health System Portage

Billing Code: 470 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 470
Insurance Median: $18,369
Cash Discount Price: $55,047
vs. Medicare Baseline: 1.31x Medicare

The contracted insurance negotiated median rate for a Hip or knee replacement (inpatient stay) at Up Health System Portage is $18,369. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $55,047. Compared to the federal Medicare reimbursement reference rate of $14,044.15, this hospital’s rate is 1.31x the Medicare baseline. Located in 500 Campus Drive, Hancock, MI.

Cash / Self-Pay

$55,047

Average discount available for prompt cash payment at this facility.

Insurance Median

$18,369

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: $55,047 (392%)

Insurance Median: $18,369 (131%)

Cash: $55,047 (392% of Medicare)

Ins. Median: $18,369 (131% 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
Advantra	$18,369	131%
Blue Cross Blue Shield	$18,369	131%
Care Plus	$18,369	131%
Caremore	$18,369	131%
Cigna	$18,369	131%
Coventry	$18,369	131%
Freedom Health	$18,369	131%
Healthnet	$18,369	131%
Healthplus	$18,369	131%
Humana	$18,369	131%
Kaiser	$18,369	131%
Medicare (plans)	$18,369	131%
Molina	$18,369	131%
Network Health	$18,369	131%
Optimum	$18,369	131%
Priority Health	$18,369	131%
Pyramid	$18,369	131%
Security Health	$18,369	131%
Ucare	$18,369	131%
Unicare	$18,369	131%
UnitedHealthcare	$18,369	131%
Universal Health Netowrk	$18,369	131%
Uphp	$18,369	131%
Wellcare	$18,369	131%
Aetna	$18,553	132%
Tricare	$19,419	138%

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 $55,047.
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 Up Health System Portage 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.