CMS Price Transparency Data

Hip or knee replacement (inpatient stay)

Facility: University of Michigan Health - West

Billing Code: 470 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 470
Insurance Median: $23,285
Cash Discount Price: $90,367
vs. Medicare Baseline: 1.66x Medicare

The contracted insurance negotiated median rate for a Hip or knee replacement (inpatient stay) at University of Michigan Health - West is $23,285. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $90,367. Compared to the federal Medicare reimbursement reference rate of $14,044.15, this hospital’s rate is 1.66x the Medicare baseline. Located in 5900 Byron Center Avenue, Sw, Wyoming, MI.

Cash / Self-Pay

$90,367

Average discount available for prompt cash payment at this facility.

Insurance Median

$23,285

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: $90,367 (643%)

Insurance Median: $23,285 (166%)

Cash: $90,367 (643% of Medicare)

Ins. Median: $23,285 (166% 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
Care Resources	$11,006	78%
Aetna	$12,229 - $24,804	87%
Humana	$12,229 - $13,242	87%
Medicare (plans)	$12,229	87%
Molina Marketplace Commercial	$12,229	87%
Insight Metro Care	$17,611	125%
Golden Rule Ins	$21,825	155%
Medica	$21,825	155%
Student Ins/Mega Life	$21,825	155%
UnitedHealthcare	$21,825	155%
Apwu	$23,285	166%
Cigna	$23,285	166%
Health Partners	$23,285	166%
Priority Health	$23,285	166%
Web Tpa	$23,285	166%
Bcn	$34,358	245%
Blue Cross Blue Shield	$34,358	245%
Alliance Health & Life Ppo	$151,365	1078%
Asr Physicians	$151,365	1078%
Hap	$151,365	1078%
Asr Cofinity	$188,642	1343%
Cofinity Commercial	$188,642	1343%
Cofinity Weyco	$188,642	1343%
Core Source	$188,642	1343%
Epoch Group	$188,642	1343%
Hlthcomp Admin	$188,642	1343%
Mid America	$188,642	1343%

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 $90,367.
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 University of Michigan Health - West 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.