CMS Price Transparency Data

Hip or knee replacement (inpatient stay)

Facility: Jfk University Medical Center

Billing Code: 470 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 470
Insurance Median: $18,792
Cash Discount Price: $16,461
vs. Medicare Baseline: 1.34x Medicare

The contracted insurance negotiated median rate for a Hip or knee replacement (inpatient stay) at Jfk University Medical Center is $18,792. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $16,461. Compared to the federal Medicare reimbursement reference rate of $14,044.15, this hospital’s rate is 1.34x the Medicare baseline. Located in 65 James Street, Edison, NJ.

Cash / Self-Pay

$16,461

Average discount available for prompt cash payment at this facility.

Insurance Median

$18,792

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: $16,461 (117%)

Insurance Median: $18,792 (134%)

Cash: $16,461 (117% of Medicare)

Ins. Median: $18,792 (134% 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	$6,947 - $76,496	49%
Amerihealth	$14,624	104%
Vaccn	$16,461	117%
Aetna	$17,084 - $45,629	122%
Amerigroup	$17,084	122%
Blue Cross Blue Shield	$17,084	122%
Wellcare	$17,084	122%
United Community/Americhoice	$17,938	128%
Clover	$18,792	134%
Seoul Medical Group	$19,134	136%
Karna	$24,454	174%
Cigna	$53,582 - $59,286	382%
Oxford	$68,189	486%
Brighton Health Plan	$75,206	535%
UnitedHealthcare	$80,711	575%

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 $16,461.
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 Jfk 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.