CMS Price Transparency Data

Hip or knee replacement (inpatient stay)

Facility: Bayshore Medical Center

Billing Code: 470 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 470
Insurance Median: $16,792
Cash Discount Price: $15,996
vs. Medicare Baseline: 1.20x Medicare

The contracted insurance negotiated median rate for a Hip or knee replacement (inpatient stay) at Bayshore Medical Center is $16,792. 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 1.20x the Medicare baseline. Located in 727 N Beers St, Holmdel, NJ.

Cash / Self-Pay

$15,996

Average discount available for prompt cash payment at this facility.

Insurance Median

$16,792

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: $15,996 (114%)

Insurance Median: $16,792 (120%)

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

Ins. Median: $16,792 (120% 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	$6,542 - $84,282	47%
Vaccn	$13,853	99%
Amerihealth	$13,939	99%
Aetna	$14,993 - $52,596	107%
Amerigroup	$14,993	107%
Blue Cross Blue Shield	$14,993	107%
Wellcare	$14,993	107%
United Community/Americhoice	$15,742	112%
Clover	$16,492	117%
Seoul Medical Group	$16,792	120%
UnitedHealthcare	$17,991 - $71,249	128%
Karna	$21,666	154%
Cigna	$51,853 - $57,187	369%
Oxford	$61,166	436%
Brighton Health Plan	$67,659	482%

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 Bayshore 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.