CMS Price Transparency Data

Hip or knee replacement (inpatient stay)

Facility: Uh St John Medical Center

Billing Code: 470 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 470
Insurance Median: $22,263
Cash Discount Price: Unavailable
vs. Medicare Baseline: 1.59x Medicare

The contracted insurance negotiated median rate for a Hip or knee replacement (inpatient stay) at Uh St John Medical Center is $22,263. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is unavailable. Compared to the federal Medicare reimbursement reference rate of $14,044.15, this hospital’s rate is 1.59x the Medicare baseline. Located in 29000 Center Ridge Road, Westlake, OH.

Cash / Self-Pay

Unavailable

Average discount available for prompt cash payment at this facility.

Insurance Median

$22,263

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%)

Insurance Median: $22,263 (159%)

Ins. Median: $22,263 (159% 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
Jp Farley	$10,978	78%
Cigna	$14,401 - $22,263	103%
University Health Employee Plan (Contigo)	$17,875	127%
Medical Mutual Of Ohio	$20,011 - $24,457	142%
Aetna	$22,263 - $39,628	159%
Blue Cross Blue Shield	$22,263 - $34,299	159%
Devoted Health	$22,263	159%
Humana	$22,263	159%
Molina	$22,263	159%
Primetime Health Plan	$22,263	159%
Summacare	$22,263 - $24,512	159%
The Health Plan	$22,263 - $24,276	159%
UnitedHealthcare	$22,263 - $41,946	159%
Wellcare By Allwell	$22,263	159%
Aultcare	$22,718	162%
Paramount	$22,931	163%
Perennial Advantage Of Ohio	$23,376	166%
Valor Health Plans	$23,376	166%
Ambetter / Centene	$40,073	285%
Caresource	$40,073	285%

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 $X.
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 Uh St John 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.