CMS Price Transparency Data

Hip or knee replacement (inpatient stay)

Facility: Cache Valley Hospital

Billing Code: 470 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 470
Insurance Median: $23,815
Cash Discount Price: Unavailable
vs. Medicare Baseline: 1.70x Medicare

The contracted insurance negotiated median rate for a Hip or knee replacement (inpatient stay) at Cache Valley Hospital is $23,815. 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 1.70x the Medicare baseline. Located in 2380 North 400 East, North Logan, UT.

Cash / Self-Pay

Unavailable

Average discount available for prompt cash payment at this facility.

Insurance Median

$23,815

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: $23,815 (170%)

Ins. Median: $23,815 (170% 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
Bright Health	$12,026	86%
Elap	$14,613	104%
Molina	$14,716	105%
Humana	$14,938 - $28,982	106%
Coventry Altius	$15,249	109%
Cigna	$15,560 - $52,415	111%
Molina Healthcare	$15,560 - $17,293	111%
State Of Utah	$15,560	111%
University Of Ut	$15,560	111%
Veteran'S Administration	$15,560	111%
Health Choice	$17,207	123%
Hosp Uncompensated Care	$17,207	123%
Aetna	$18,171 - $30,197	129%
Regence	$19,022 - $31,568	135%
Angle Insurance	$20,394	145%
University Of Utah	$22,434 - $29,539	160%
Pehp	$28,449 - $35,162	203%
Motivhealth	$34,475	245%
Imagine Health Wise	$36,707	261%
Dmba (Deseret Mutual Benefit Admin)	$38,911	277%

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 Cache Valley 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.