CMS Price Transparency Data

Hip or knee replacement (inpatient stay)

Facility: Robert Wood Johnson University Hospital at Hamilton

Billing Code: 470 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 470
Insurance Median: $28,953
Cash Discount Price: $3,233
vs. Medicare Baseline: 2.06x Medicare

The contracted insurance negotiated median rate for a Hip or knee replacement (inpatient stay) at Robert Wood Johnson University Hospital at Hamilton is $28,953. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $3,233. Compared to the federal Medicare reimbursement reference rate of $14,044.15, this hospital’s rate is 2.06x the Medicare baseline. Located in One Hamilton Health Place, Hamilton, NJ.

Cash / Self-Pay

$3,233

Average discount available for prompt cash payment at this facility.

Insurance Median

$28,953

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: $3,233 (23%)

Insurance Median: $28,953 (206%)

Cash: $3,233 (23% of Medicare)

Ins. Median: $28,953 (206% 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.

Elevated Commercial Rate Alert (Value-Gap)

The negotiated rate at this facility is 206% of the Medicare baseline (a markup of 106%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.

Consult Patient Advocate

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	$6,740 - $41,323	48%
Aetna	$15,021 - $38,166	107%
Clover Health	$15,021	107%
Fidelis Care	$15,021	107%
Humana	$15,021	107%
Wellpoint	$15,021	107%
UnitedHealthcare	$15,322 - $38,000	109%
Cigna	$21,420 - $28,666	153%
Emblem Health	$22,964	164%
Qualcare Inc	$25,095 - $37,644	179%
Amerihealth	$29,239 - $30,965	208%
Wellcare	$29,892	213%

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 $3,233.
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 Robert Wood Johnson University Hospital at Hamilton 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.