Hip or knee replacement (inpatient stay)
Facility: Adventist Health Portland
Billing Code: 470 (MS-DRG)
- CPT Billing Code: 470
- Insurance Median: $29,450
- Cash Discount Price: $31,545
- vs. Medicare Baseline: 2.10x Medicare
Average discount available for prompt cash payment at this facility.
Median negotiated contract rate across all mapped commercial carriers.
Standard federal government reimbursement rate for this code.
Visual Cost Comparison vs. 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 210% of the Medicare baseline (a markup of 110%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.
Out-of-Pocket Cost Estimator
Estimate whether it is more economical to use your insurance or pay the upfront self-pay cash rate.
Commercial Insurance Negotiated Rates
Negotiated contract ranges established by major commercial carriers at this facility.
| Carrier / Plan Group | Contract Rate Range | vs. Medicare Reference |
|---|---|---|
| Ods - All Plans | $11,551 | 82% |
| Care Oregon - All Plans | $13,907 | 99% |
| Kaiser Mcr Adv | $16,361 | 116% |
| Humana | $16,688 - $17,343 | 119% |
| Bc Premera First - All Plans | $16,897 | 120% |
| Healthcare Resources - All Plans | $17,179 | 122% |
| Moda Mcr Adv | $17,343 | 123% |
| UnitedHealthcare | $17,343 - $41,815 | 123% |
| Healthnet Mcr Adv | $18,815 | 134% |
| Trillium Comm Hp Mcaid - All Plans | $19,306 | 137% |
| Regence Preferred Mcr Adv | $22,605 | 161% |
| Cigna | $24,169 | 172% |
| Regence Mcr Adv | $24,775 | 176% |
| Regence Ohsu Plus | $25,659 | 183% |
| Moda Affinity - All Other Plans | $27,005 | 192% |
| Moda Select | $28,162 | 201% |
| Kaiser - All Other Plans | $29,007 | 207% |
| Ah Employee Health Plan - All Plans | $29,450 | 210% |
| Moda Ohsu Ppo/Epo/Hmc | $29,450 | 210% |
| Moda Synergy | $30,862 | 220% |
| Healthnet Hmo/Pos - All Other Plans | $31,055 | 221% |
| First Health-Coventry - All Plans | $31,146 | 222% |
| Moda Conn Oebb/Syn Pebb | $32,722 | 233% |
| Workers Comp | $34,108 | 243% |
| Healthnet Epo/Pos/Ppo | $34,527 | 246% |
| Regence - All Other Plans | $34,556 | 246% |
| Providence Hp - All Plans | $36,070 | 257% |
| Moda Connexus | $48,030 | 342% |
| Aetna | $51,887 | 369% |
| Pacific Source Comm - All Plans | $53,823 | 383% |
| Worldventure - All Plans | $59,146 | 421% |
| First Choice - All Plans | $68,314 | 486% |
| Multiplan - All Plans | $73,933 | 526% |
| Phcs - All Plans | $73,933 | 526% |
| Health Payors Organization Ltd- All Plans | $78,862 | 562% |
| National Provider Network - All Plans | $86,748 | 618% |