CMS Price Transparency Data
Hip or knee replacement (inpatient stay)
Facility: Chilton Medical Center
Billing Code: 470 (MS-DRG)
Factual Cost Summary (Answer Capsule)
- CPT Billing Code: 470
- Insurance Median: $19,833
- Cash Discount Price: $19,779
- vs. Medicare Baseline: 1.41x Medicare
The contracted insurance negotiated median rate for a Hip or knee replacement (inpatient stay) at Chilton Medical Center is $19,833. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $19,779. Compared to the federal Medicare reimbursement reference rate of $14,044.15, this hospital’s rate is 1.41x the Medicare baseline. Located in 97 West Parkway, Pompton Plains, NJ.
Cash / Self-Pay
$19,779
Average discount available for prompt cash payment at this facility.
Insurance Median
$19,833
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: $19,779 (141%)
Insurance Median: $19,833 (141%)
Cash: $19,779 (141% of Medicare)
Ins. Median: $19,833 (141% 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.
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 |
|---|---|---|
| Luminare Health AHS Retiree [5013] | $5,203 - $20,463 | 37% |
| Aetna | $5,941 - $38,570 | 42% |
| Blue Cross Blue Shield | $5,941 - $42,442 | 42% |
| Medicaid / KanCare | $5,941 - $18,197 | 42% |
| Untd Hlth Community Plan Behavioral Health [5293] | $5,941 - $10,208 | 42% |
| Untd Hlth Community Plan [5034] | $5,941 - $10,208 | 42% |
| 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% |
| Kessler Foundation [5532] | $12,000 | 85% |
| Karen Ann Quinlan [5285] | $12,659 | 90% |
| Cigna | $15,823 - $49,487 | 113% |
| Medicare (plans) | $15,823 - $17,405 | 113% |
| VA Community Care Network [5403] | $15,823 | 113% |
| Amerihealth Administrators Supplemental [5512] | $16,140 | 115% |
| Amerihealth Medigap [5049] | $16,140 | 115% |
| Wellcare Behavioral Health [5335] | $16,931 | 121% |
| Wellcare Health Plans Ip Splits [5475] | $16,931 | 121% |
| Wellcare Health Plans [5269] | $16,931 | 121% |
| Highmark Wholecare Health Plan Ip Splits [5464] | $17,405 | 124% |
| Highmark Wholecare Health Plan [5413] | $17,405 | 124% |
| Kindred Giralda Hospital [5341] | $17,405 | 124% |
| UPMC [5455] | $17,405 | 124% |
| Cosmetic Surgery/Lap Band/Gastric Bypass [5289] | $18,197 | 130% |
| Specialty Imaging [5433] | $18,197 | 130% |
| Qualcare [5026] | $18,606 - $43,965 | 132% |
| Sedgwick Wtc Health Program Wc [5514] | $19,779 | 141% |
| Champva [5354] | $19,833 | 141% |
| Tricare | $19,833 | 141% |
| Us Family Health Plan [5258] | $19,833 | 141% |
| Oxford Behavioral Health [5291] | $28,530 | 203% |
| Oxford [5024] | $28,530 | 203% |
| UnitedHealthcare | $28,530 - $29,412 | 203% |
| Apwu Healthcare [5053] | $29,412 | 209% |
| Geha [5119] | $29,412 | 209% |
| Golden Rule Insurance [5124] | $29,412 | 209% |
| Harvard Pilgrim Healthcare [5133] | $29,412 | 209% |
| Ntca [5208] | $29,412 | 209% |
| Surest [5437] | $29,412 | 209% |
| Claim Watcher/Homestead [5488] | $30,064 | 214% |
| Fairos [5491] | $30,222 | 215% |
| Ambetter / Centene | $32,596 | 232% |
| Claimdoc [5434] | $34,969 | 249% |
| Bundled Cases/Episodic Payment [5492] | $37,971 | 270% |
| 1199 Seiu Benefit and Pension [5037] | $38,570 | 275% |
| Allied Benefit Systems [5046] | $38,570 - $49,487 | 275% |
| Banner Health Network [5510] | $38,570 | 275% |
| Boon-Chapman [5441] | $38,570 | 275% |
| Christian Brothers Services [5439] | $38,570 | 275% |
| Continental Assurance [5091] | $38,570 | 275% |
| Evolution Healthcare [5438] | $38,570 - $44,988 | 275% |
| Healthez [5445] | $38,570 - $44,988 | 275% |
| Healthsmart Benefit Solutions [5446] | $38,570 | 275% |
| Luminare Health Benefits [5483] | $38,570 | 275% |
| Marpai Health [5449] | $38,570 | 275% |
| Meritain Health [5185] | $38,570 | 275% |
| Nippon Benefit Life [5201] | $38,570 | 275% |
| Starmark [5240] | $38,570 | 275% |
| Webtpa [5447] | $38,570 - $44,988 | 275% |
| Independence Bc [5479] | $42,442 | 302% |
| Prime Healthcare [5435] | $42,442 | 302% |
| Ghi Emblem Health [5122] | $43,965 | 313% |
| Humana | $43,965 | 313% |
| Ila Local 1478-2 Welfare Fund [5448] | $43,965 | 313% |
| Oscar [5213] | $43,965 | 313% |
| Mvp Health Care [5197] | $44,988 | 320% |
| Nalc [5198] | $44,988 | 320% |
| Tufts Health Plan [5344] | $44,988 | 320% |
| Centivo [5405] | $45,680 - $49,487 | 325% |
| Iaa - Insurance Administrators of America [5482] | $49,487 | 352% |