CMS Price Transparency Data
Hip or knee replacement (inpatient stay)
Facility: Overlook Medical Center
Billing Code: 470 (MS-DRG)
Factual Cost Summary (Answer Capsule)
- CPT Billing Code: 470
- Insurance Median: $20,716
- Cash Discount Price: $22,517
- vs. Medicare Baseline: 1.48x Medicare
The contracted insurance negotiated median rate for a Hip or knee replacement (inpatient stay) at Overlook Medical Center is $20,716. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $22,517. Compared to the federal Medicare reimbursement reference rate of $14,044.15, this hospital’s rate is 1.48x the Medicare baseline. Located in 99 Beauvoir Avenue, Summit, NJ.
Cash / Self-Pay
$22,517
Average discount available for prompt cash payment at this facility.
Insurance Median
$20,716
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: $22,517 (160%)
Insurance Median: $20,716 (148%)
Cash: $22,517 (160% of Medicare)
Ins. Median: $20,716 (148% 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 |
|---|---|---|
| Blue Cross Blue Shield | $1,531 - $47,170 | 11% |
| Luminare Health AHS Retiree [5013] | $5,203 - $20,463 | 37% |
| Aetna | $5,941 - $48,356 | 42% |
| Medicaid / KanCare | $5,941 - $20,716 | 42% |
| Untd Hlth Community Plan Behavioral Health [5293] | $5,941 - $10,208 | 42% |
| Untd Hlth Community Plan [5034] | $5,941 - $10,208 | 42% |
| 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% |
| Kessler Foundation [5532] | $12,000 | 85% |
| Karen Ann Quinlan [5285] | $14,411 | 103% |
| Cigna | $16,359 - $49,739 | 116% |
| Medicare (plans) | $16,359 - $18,915 | 116% |
| Amerihealth Administrators Supplemental [5512] | $16,686 | 119% |
| Amerihealth Medigap [5049] | $16,686 | 119% |
| Wellcare Behavioral Health [5335] | $17,504 | 125% |
| Wellcare Health Plans Ip Splits [5475] | $17,504 | 125% |
| Wellcare Health Plans [5269] | $17,504 | 125% |
| Highmark Wholecare Health Plan Ip Splits [5464] | $17,994 | 128% |
| Highmark Wholecare Health Plan [5413] | $17,994 | 128% |
| UPMC [5455] | $17,994 | 128% |
| VA Community Care Network [5403] | $18,014 | 128% |
| Kindred Giralda Hospital [5341] | $19,815 | 141% |
| Champva [5354] | $19,833 | 141% |
| Tricare | $19,833 | 141% |
| Us Family Health Plan [5258] | $19,833 | 141% |
| Cosmetic Surgery/Lap Band/Gastric Bypass [5289] | $20,716 | 148% |
| Omc Pediatric Muscle Lengthening [5360] | $20,716 | 148% |
| Specialty Imaging [5433] | $20,716 | 148% |
| Sedgwick Wtc Health Program Wc [5514] | $22,517 | 160% |
| Wtc Health Program [5273] | $24,018 | 171% |
| Oxford Behavioral Health [5291] | $29,610 | 211% |
| Oxford [5024] | $29,610 | 211% |
| UnitedHealthcare | $29,610 - $30,527 | 211% |
| Apwu Healthcare [5053] | $30,527 | 217% |
| Geha [5119] | $30,527 | 217% |
| Golden Rule Insurance [5124] | $30,527 | 217% |
| Harvard Pilgrim Healthcare [5133] | $30,527 | 217% |
| Ntca [5208] | $30,527 | 217% |
| Surest [5437] | $30,527 | 217% |
| Claim Watcher/Homestead [5488] | $31,081 | 221% |
| Fairos [5491] | $34,406 | 245% |
| Ambetter / Centene | $37,108 | 264% |
| Bundled Cases/Episodic Payment [5492] | $37,971 | 270% |
| Claimdoc [5434] | $39,811 | 283% |
| 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% |
| Qualcare [5026] | $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% |