CMS Price Transparency Data

Hip or knee replacement (inpatient stay)

Facility: Jersey Shore University Medical Center

Billing Code: 470 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 470
Insurance Median: $18,716
Cash Discount Price: $15,996
vs. Medicare Baseline: 1.33x Medicare

The contracted insurance negotiated median rate for a Hip or knee replacement (inpatient stay) at Jersey Shore University Medical Center is $18,716. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $15,996. Compared to the federal Medicare reimbursement reference rate of $14,044.15, this hospital’s rate is 1.33x the Medicare baseline. Located in 1945 Rte 33, Neptune, NJ.

Cash / Self-Pay

$15,996

Average discount available for prompt cash payment at this facility.

Insurance Median

$18,716

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: $15,996 (114%)

Insurance Median: $18,716 (133%)

Cash: $15,996 (114% of Medicare)

Ins. Median: $18,716 (133% 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
UnitedHealthcare	$13,612 - $80,322	97%
Amerihealth	$15,443	110%
Vaccn	$15,996	114%
Horizon	$16,183 - $114,356	115%
Aetna	$17,015 - $80,434	121%
Ubh	$17,015	121%
Wellcare	$17,015	121%
Amerigroup	$17,015	121%
Blue Cross Blue Shield	$17,015	121%
United Community/Americhoice	$17,865	127%
Clover	$18,716	133%
Seoul Medical Group	$19,056	136%
Karna	$24,362	173%
Cigna	$54,985 - $60,838	392%
Oxford	$74,888	533%
Brighton Health Plan	$75,206	535%

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 $15,996.
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 Jersey Shore University 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.