CMS Price Transparency Data

Hip or knee replacement (inpatient stay)

Facility: Saint Clare's Hospital/ Denville Campus

Billing Code: 470 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 470
Insurance Median: $19,993
Cash Discount Price: $17,713
vs. Medicare Baseline: 1.42x Medicare

The contracted insurance negotiated median rate for a Hip or knee replacement (inpatient stay) at Saint Clare's Hospital/ Denville Campus is $19,993. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $17,713. Compared to the federal Medicare reimbursement reference rate of $14,044.15, this hospital’s rate is 1.42x the Medicare baseline. Located in 25 Pocono Road, Denville, NJ.

Cash / Self-Pay

$17,713

Average discount available for prompt cash payment at this facility.

Insurance Median

$19,993

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: $17,713 (126%)

Insurance Median: $19,993 (142%)

Cash: $17,713 (126% of Medicare)

Ins. Median: $19,993 (142% 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
Horizon	$12,164 - $16,736	87%
Humana	$14,171	101%
Aetna	$16,736 - $32,062	119%
Amerihealth	$16,736	119%
Clover Health	$16,736	119%
UnitedHealthcare	$16,736 - $27,718	119%
Wellcare	$16,736 - $23,914	119%
Wellpoint Amerigroup	$16,736	119%
Medicare (plans)	$17,714	126%
Ally-Align (Fka Spartan Health Plan)	$18,599	132%
Employer Direct Healthcare	$23,028	164%
Cigna	$24,304	173%
Tricare	$25,391	181%
Fairprice Healthcare Holdings - Fphh	$28,342	202%
Coventry	$30,113	214%

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 $17,713.
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 Saint Clare's Hospital/ Denville Campus 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.