CMS Price Transparency Data

Hip or knee replacement (inpatient stay)

Facility: North Memorial Health Hospital

Billing Code: 470 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 470
Insurance Median: $15,829
Cash Discount Price: $19,243
vs. Medicare Baseline: 1.13x Medicare

The contracted insurance negotiated median rate for a Hip or knee replacement (inpatient stay) at North Memorial Health Hospital is $15,829. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $19,243. Compared to the federal Medicare reimbursement reference rate of $14,044.15, this hospital’s rate is 1.13x the Medicare baseline. Located in 3300 Oakdale North, Robbinsdale, MN.

Cash / Self-Pay

$19,243

Average discount available for prompt cash payment at this facility.

Insurance Median

$15,829

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: $19,243 (137%)

Insurance Median: $15,829 (113%)

Cash: $19,243 (137% of Medicare)

Ins. Median: $15,829 (113% 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
Medica [1086]	$14,243 - $33,914	101%
Humana	$14,534	103%
Health Partners [1061]	$14,563 - $29,792	104%
Blue Cross Blue Shield	$14,825	106%
Ucare [1148]	$14,825 - $26,161	106%
Medicare (plans)	$14,996	107%
UnitedHealthcare	$15,115 - $35,721	108%
Aetna	$16,133	115%
Cigna	$31,021	221%

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 $19,243.
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 North Memorial Health 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.