CMS Price Transparency Data

Hip or knee replacement (inpatient stay)

Facility: Trinitas Regional Medical Center

Billing Code: 470 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 470
Insurance Median: $25,246
Cash Discount Price: $2,726
vs. Medicare Baseline: 1.80x Medicare

The contracted insurance negotiated median rate for a Hip or knee replacement (inpatient stay) at Trinitas Regional Medical Center is $25,246. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $2,726. Compared to the federal Medicare reimbursement reference rate of $14,044.15, this hospital’s rate is 1.80x the Medicare baseline. Located in 225 Williamson Street, Elizabeth, NJ.

Cash / Self-Pay

$2,726

Average discount available for prompt cash payment at this facility.

Insurance Median

$25,246

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: $2,726 (19%)

Insurance Median: $25,246 (180%)

Cash: $2,726 (19% of Medicare)

Ins. Median: $25,246 (180% 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
Blue Cross Blue Shield	$3,699 - $47,391	26%
Amerihealth	$4,080	29%
Humana	$17,905	127%
Fidelis Care	$17,905	127%
Wellpoint	$17,905	127%
Clover Health	$17,905	127%
Aetna	$17,905 - $35,862	127%
UnitedHealthcare	$18,263 - $38,000	130%
Cigna	$23,970 - $25,246	171%
Qualcare Inc	$27,044	193%
Wellcare	$35,631	254%
Emblem Health	$37,139	264%

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 $2,726.
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 Trinitas Regional 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.