CMS Price Transparency Data

Hip or knee replacement (inpatient stay)

Facility: Barnes Jewish Hospital

Billing Code: 470 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 470
Insurance Median: $36,149
Cash Discount Price: $48,007
vs. Medicare Baseline: 2.57x Medicare

The contracted insurance negotiated median rate for a Hip or knee replacement (inpatient stay) at Barnes Jewish Hospital is $36,149. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $48,007. Compared to the federal Medicare reimbursement reference rate of $14,044.15, this hospital’s rate is 2.57x the Medicare baseline. Located in One Barnes-Jewish Hospital Plaza, Saint Louis, MO.

Cash / Self-Pay

$48,007

Average discount available for prompt cash payment at this facility.

Insurance Median

$36,149

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: $48,007 (342%)

Insurance Median: $36,149 (257%)

Cash: $48,007 (342% of Medicare)

Ins. Median: $36,149 (257% 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 257% of the Medicare baseline (a markup of 157%). 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
Aetna	$16,269 - $39,328	116%
Blue Cross Blue Shield	$16,269 - $45,031	116%
Essence Healthcare [221]	$16,269	116%
Humana	$16,269 - $42,757	116%
UnitedHealthcare	$16,269 - $21,939	116%
Cox Health [757]	$17,082	122%
Devoted Health Plan [847]	$17,082	122%
Medica [662]	$17,082	122%
Cigna	$20,989 - $36,448	149%
Healthscope Benefits [258]	$21,939	156%
Health Alliance [224]	$28,509	203%
Consociate [478]	$35,288 - $40,580	251%
Apwu Health Plan [216]	$36,448	260%
Nalc Health Benefit Plan [242]	$36,448	260%
Priority Health [648]	$36,448	260%
Allied Benefits [498]	$39,328	280%
Coresource [497]	$39,328	280%
Fmh Benefit Service Inc [222]	$39,328	280%
Mail Handlers [495]	$39,328	280%
Sarah Bush Lincoln [636]	$40,580	289%

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 $48,007.
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 Barnes Jewish 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.