CMS Price Transparency Data

Hip or knee replacement (inpatient stay)

Facility: Lone Peak Hospital

Billing Code: 470 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 470
Insurance Median: $20,394
Cash Discount Price: Unavailable
vs. Medicare Baseline: 1.45x Medicare

The contracted insurance negotiated median rate for a Hip or knee replacement (inpatient stay) at Lone Peak Hospital is $20,394. 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 1.45x the Medicare baseline. Located in 11925 South State Street, Draper, UT.

Cash / Self-Pay

Unavailable

Average discount available for prompt cash payment at this facility.

Insurance Median

$20,394

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: $20,394 (145%)

Ins. Median: $20,394 (145% 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
Aetna	$3,564 - $29,445	25%
Bright Health	$12,026	86%
Humana	$12,689 - $28,982	90%
Coventry Altius	$12,953	92%
Cigna	$13,218 - $52,415	94%
Molina Healthcare	$13,218 - $17,293	94%
State Of Utah	$13,218	94%
Triwest Healthcare Alliance	$13,218	94%
University Of Ut	$13,218	94%
Veteran'S Administration	$13,218	94%
Blue Cross Blue Shield	$13,350	95%
Sterling Life Insurance	$14,143	101%
Molina	$14,716	105%
Health Choice	$17,207	123%
Hosp Uncompensated Care	$17,207	123%
Regence	$17,458 - $28,974	124%
Elap	$19,521	139%
Angle Insurance	$20,394	145%
University Of Utah	$23,254 - $31,080	166%
Pehp	$29,577 - $37,437	211%
Multiplan	$34,876	248%
Motivhealth	$37,117	264%
Imagine Health Wise	$38,659	275%
Dmba (Deseret Mutual Benefit Admin)	$40,142	286%

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 Lone Peak 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.