CMS Price Transparency Data

Hip or knee replacement (inpatient stay)

Facility: University Medical Center of Princeton at Plainsboro

Billing Code: 470 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 470
Insurance Median: $15,736
Cash Discount Price: Unavailable
vs. Medicare Baseline: 1.12x Medicare

The contracted insurance negotiated median rate for a Hip or knee replacement (inpatient stay) at University Medical Center of Princeton at Plainsboro is $15,736. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is unavailable. Compared to the federal Medicare reimbursement reference rate of $14,044.15, this hospital’s rate is 1.12x the Medicare baseline. Located in One-Five Plainsboro Road, Plainsboro, NJ.

Cash / Self-Pay

Unavailable

Average discount available for prompt cash payment at this facility.

Insurance Median

$15,736

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%)

Insurance Median: $15,736 (112%)

Ins. Median: $15,736 (112% 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
Private Healthcare Systems	$1,700	12%
Coventry	$1,903	14%
Princeton Theological Seminary	$1,907	14%
Blue Cross Blue Shield	$1,954 - $28,438	14%
UnitedHealthcare	$2,288 - $15,736	16%
Amerihealth	$2,478	18%
Qualcare	$2,672 - $2,973	19%
Health Net	$3,065	22%
Devon Health Services	$5,223	37%
Magnacare	$5,693	41%
Consumer Health Network	$6,075	43%
First Managed Care Option	$7,232	51%
Us Family Health Plan	$9,660	69%
Horizon Nj Health	$12,694	90%
Aetna	$15,736 - $27,163	112%
Medicare (plans)	$15,736 - $17,306	112%
Va Medical Center	$15,736	112%
Cigna	$16,208 - $22,422	115%
Clover Health Plan	$16,677	119%
Humana	$16,992	121%
Elap	$24,197 - $28,320	172%
Claim Watcher	$30,672	218%
Centivo	$30,727	219%

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 $X.
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 Medical Center of Princeton at Plainsboro 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.