CMS Price Transparency Data

Hip or knee replacement (inpatient stay)

Facility: Bay Area Hospital

Billing Code: 470 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 470
Insurance Median: $38,385
Cash Discount Price: $40,198
vs. Medicare Baseline: 2.73x Medicare

The contracted insurance negotiated median rate for a Hip or knee replacement (inpatient stay) at Bay Area Hospital is $38,385. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $40,198. Compared to the federal Medicare reimbursement reference rate of $14,044.15, this hospital’s rate is 2.73x the Medicare baseline. Located in 1775 Thompson Road, Coos Bay, OR.

Cash / Self-Pay

$40,198

Average discount available for prompt cash payment at this facility.

Insurance Median

$38,385

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: $40,198 (286%)

Insurance Median: $38,385 (273%)

Cash: $40,198 (286% of Medicare)

Ins. Median: $38,385 (273% 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 273% of the Medicare baseline (a markup of 173%). 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
Healthnet Mcaid	$12,937	92%
Southwest Oregon Ipa - All Plans	$13,422	96%
Healthnet Mcr Adv	$17,465	124%
Ods Ppo/Pos - All Plans	$30,862	220%
Nasomah Hlth Grp - All Plans	$32,158	229%
Moda Hlth Mcr Adv	$34,173	243%
Providence - All Other Plans	$34,720	247%
Providence Pebb	$34,720	247%
Blue Cross Blue Shield	$38,385	273%
Moda Beacon - All Other Plans	$43,003	306%
Pacificsource - All Plans	$45,558	324%
First Choice - All Plans	$47,837	341%
Aetna	$49,310	351%
Cigna	$49,310	351%
Moda Connexus/Synergy	$50,198	357%
Healthnet Comm- All Other Plans	$50,918	363%
UnitedHealthcare	$50,918	363%

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 $40,198.
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 Bay Area Hospital 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.