CMS Price Transparency Data
Hip or knee replacement (inpatient stay)
Facility: Morristown Medical Center
Billing Code: 470 (MS-DRG)
Factual Cost Summary (Answer Capsule)
- CPT Billing Code: 470
- Insurance Median: $37,998
- Cash Discount Price: $23,074
- vs. Medicare Baseline: 2.71x Medicare
The contracted insurance negotiated median rate for a Hip or knee replacement (inpatient stay) at Morristown Medical Center is $37,998. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $23,074. Compared to the federal Medicare reimbursement reference rate of $14,044.15, this hospital’s rate is 2.71x the Medicare baseline. Located in 100 Madison Ave, Morristown, NJ.
Cash / Self-Pay
$23,074
Average discount available for prompt cash payment at this facility.
Insurance Median
$37,998
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: $23,074 (164%)
Insurance Median: $37,998 (271%)
Cash: $23,074 (164% of Medicare)
Ins. Median: $37,998 (271% 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 271% of the Medicare baseline (a markup of 171%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.
Out-of-Pocket Cost Estimator
Estimate whether it is more economical to use your insurance or pay the upfront self-pay cash 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 |
|---|---|---|
| Seafarers Health and Benefits Plan [5343] | $2,101 | 15% |
| Luminare Health AHS Retiree [5013] | $5,203 - $20,463 | 37% |
| Aetna | $7,129 - $48,356 | 51% |
| Blue Cross Blue Shield | $7,129 - $47,170 | 51% |
| Medicaid / KanCare | $7,129 - $21,228 | 51% |
| Untd Hlth Community Plan Behavioral Health [5293] | $7,129 - $12,250 | 51% |
| Untd Hlth Community Plan [5034] | $7,129 - $12,250 | 51% |
| Wellpath Correctional [5485] | $7,129 - $12,250 | 51% |
| Occunet [5490] | $7,532 | 54% |
| The Fairly Group [5528] | $7,532 | 54% |
| Praxis Workers Comp [5515] | $8,500 | 61% |
| Inservco Workers Compensation [5158] | $8,682 | 62% |
| Medlogix/Consumer Health Network (Chn) [5415] | $8,682 | 62% |
| Gallagher Bassett Workers Comp [5117] | $9,028 | 64% |
| Liberty Mutual Worker's Comp [5174] | $9,028 | 64% |
| Pma Workers Comp [5224] | $9,028 | 64% |
| Sedgwick [5235] | $9,028 | 64% |
| Sentry Worker's Comp [5489] | $9,028 | 64% |
| Travelers Workers Compensation [5250] | $9,028 | 64% |
| Karen Ann Quinlan [5285] | $14,767 | 105% |
| Cigna | $16,715 - $49,739 | 119% |
| Medicare (plans) | $16,715 - $84,542 | 119% |
| Amerihealth Administrators Supplemental [5512] | $17,050 | 121% |
| Amerihealth Medigap [5049] | $17,050 | 121% |
| Wellcare Behavioral Health [5335] | $17,885 | 127% |
| Wellcare Health Plans Ip Splits [5475] | $17,885 | 127% |
| Wellcare Health Plans [5269] | $17,885 | 127% |
| Highmark Wholecare Health Plan Ip Splits [5464] | $18,387 | 131% |
| Highmark Wholecare Health Plan [5413] | $18,387 | 131% |
| UPMC [5455] | $18,387 | 131% |
| VA Community Care Network [5403] | $18,459 | 131% |
| Champva [5354] | $19,833 | 141% |
| Tricare | $19,833 | 141% |
| Us Family Health Plan [5258] | $19,833 | 141% |
| Kindred Giralda Hospital [5341] | $20,305 | 145% |
| Qualcare [5026] | $20,538 - $43,965 | 146% |
| Cosmetic Surgery/Lap Band/Gastric Bypass [5289] | $21,228 | 151% |
| Specialty Imaging [5433] | $21,228 | 151% |
| Sedgwick Wtc Health Program Wc [5514] | $23,074 | 164% |
| Chubb Health [5073] | $23,828 - $93,719 | 170% |
| Wtc Health Program [5273] | $24,612 | 175% |
| Claim Watcher/Homestead [5488] | $31,759 | 226% |
| Fairos [5491] | $35,257 | 251% |
| Bundled Cases/Episodic Payment [5492] | $37,971 | 270% |
| Ambetter / Centene | $38,025 | 271% |
| Claimdoc [5434] | $40,794 - $84,542 | 290% |
| Ghi Emblem Health [5122] | $43,965 - $84,542 | 313% |
| Humana | $43,965 | 313% |
| Ila Local 1478-2 Welfare Fund [5448] | $43,965 | 313% |
| Oscar [5213] | $43,965 | 313% |
| Evolution Healthcare [5438] | $45,217 - $48,356 | 322% |
| Healthez [5445] | $45,217 - $48,356 | 322% |
| Mvp Health Care [5197] | $45,217 | 322% |
| Nalc [5198] | $45,217 | 322% |
| Tufts Health Plan [5344] | $45,217 | 322% |
| Webtpa [5447] | $45,217 - $48,356 | 322% |
| Centivo [5405] | $45,680 - $49,739 | 325% |
| Independence Bc [5479] | $47,170 | 336% |
| Prime Healthcare [5435] | $47,170 | 336% |
| 1199 Seiu Benefit and Pension [5037] | $48,356 | 344% |
| Allied Benefit Systems [5046] | $48,356 - $49,739 | 344% |
| Banner Health Network [5510] | $48,356 | 344% |
| Boon-Chapman [5441] | $48,356 | 344% |
| Christian Brothers Services [5439] | $48,356 | 344% |
| Continental Assurance [5091] | $48,356 | 344% |
| Healthsmart Benefit Solutions [5446] | $48,356 | 344% |
| Luminare Health Benefits [5483] | $48,356 | 344% |
| Marpai Health [5449] | $48,356 | 344% |
| Meritain Health [5185] | $48,356 | 344% |
| Nippon Benefit Life [5201] | $48,356 | 344% |
| Starmark [5240] | $48,356 | 344% |
| Iaa - Insurance Administrators of America [5482] | $49,739 | 354% |
| Oxford Behavioral Health [5291] | $50,337 | 358% |
| Oxford [5024] | $50,337 | 358% |
| UnitedHealthcare | $50,337 - $51,895 | 358% |
| Apwu Healthcare [5053] | $51,895 | 370% |
| Geha [5119] | $51,895 | 370% |
| Golden Rule Insurance [5124] | $51,895 | 370% |
| Harvard Pilgrim Healthcare [5133] | $51,895 | 370% |
| Ntca [5208] | $51,895 | 370% |
| Surest [5437] | $51,895 | 370% |
| Bankers Life & Casualty Supplemental [5058] | $84,542 | 602% |
| Bollinger [5065] | $84,542 | 602% |
| Concern Non Employee [5086] | $84,542 | 602% |
| Continental Casualty [5093] | $84,542 | 602% |
| Generic Commercial [5015] | $84,542 | 602% |
| Generic No Fault [5017] | $84,542 | 602% |
| Health Net [5137] | $84,542 | 602% |
| Kessler Institute for Rehab [5166] | $84,542 | 602% |
| Magellan [5176] | $84,542 | 602% |
| Mutual of Omaha [5195] | $84,542 | 602% |
| Out of Country Insurance Plan [5215] | $84,542 | 602% |
| Runnells Specialized Hospital [5233] | $84,542 | 602% |
| The Health Plan [5451] | $84,542 | 602% |
| Work Med [5271] | $84,542 | 602% |