CMS Price Transparency Data

Hip or knee replacement (inpatient stay)

Facility: Saint Alphonsus Medical Center Ontario

Billing Code: 470 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 470
Insurance Median: $33,070
Cash Discount Price: $33,259
vs. Medicare Baseline: 2.35x Medicare

The contracted insurance negotiated median rate for a Hip or knee replacement (inpatient stay) at Saint Alphonsus Medical Center Ontario is $33,070. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $33,259. Compared to the federal Medicare reimbursement reference rate of $14,044.15, this hospital’s rate is 2.35x the Medicare baseline. Located in 351 Sw 9Th Street, Ontario, OR.

Cash / Self-Pay

$33,259

Average discount available for prompt cash payment at this facility.

Insurance Median

$33,070

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: $33,259 (237%)

Insurance Median: $33,070 (235%)

Cash: $33,259 (237% of Medicare)

Ins. Median: $33,070 (235% 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 235% of the Medicare baseline (a markup of 135%). 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	$16,818 - $36,086	120%
Medicare (plans)	$16,818 - $18,019	120%
UnitedHealthcare	$16,818	120%
Aetna	$17,322	123%
American Health Advantage Of Idaho	$17,490	125%
Moda Health	$25,000 - $30,890	178%
Mountain Health Co-Op	$31,359	223%
Selecthealth	$31,818 - $35,196	227%
Webtpa	$34,322	244%
Blue Benefit Administrators Of Massachusetts	$36,035	257%
Blue Care Network	$36,035	257%
Blue Distinction Transplant	$36,035	257%
Blue Shield - Ca	$36,035	257%
Blue Shield - Id (Regence)	$36,035	257%
Blue Shield - Ny Highmark Northeastern	$36,035	257%
Blue Shield - Ny Highmark Western	$36,035	257%
Blue Shield - Pa (Highmark)	$36,035	257%
Blue Shield - Wa (Regence)	$36,035	257%
Healthcare Management Admin	$36,261	258%

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 $33,259.
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 Saint Alphonsus Medical Center Ontario 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.