CMS Price Transparency Data

Hip or knee replacement (inpatient stay)

Facility: Clara Maass Medical Center

Billing Code: 470 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 470
Insurance Median: $27,222
Cash Discount Price: $2,335
vs. Medicare Baseline: 1.94x Medicare

The contracted insurance negotiated median rate for a Hip or knee replacement (inpatient stay) at Clara Maass Medical Center is $27,222. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $2,335. Compared to the federal Medicare reimbursement reference rate of $14,044.15, this hospital’s rate is 1.94x the Medicare baseline. Located in One Clara Maass Drive, Belleville, NJ.

Cash / Self-Pay

$2,335

Average discount available for prompt cash payment at this facility.

Insurance Median

$27,222

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: $2,335 (17%)

Insurance Median: $27,222 (194%)

Cash: $2,335 (17% of Medicare)

Ins. Median: $27,222 (194% 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
Wellpoint	$1,885 - $16,197	13%
Qualcare Inc	$5,673 - $5,944	40%
Blue Cross Blue Shield	$5,802 - $43,634	41%
Aetna	$16,197 - $39,258	115%
Clover Health	$16,197	115%
Fidelis Care	$16,197	115%
Humana	$16,197	115%
UnitedHealthcare	$16,521 - $38,000	118%
Cigna	$21,525 - $28,807	153%
Emblem Health	$27,093	193%
Amerihealth	$29,239 - $30,965	208%
Wellcare	$32,232	230%

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 $2,335.
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 Clara Maass Medical Center 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.