CMS Price Transparency Data

Hip or knee replacement (inpatient stay)

Facility: Island Hospital

Billing Code: 470 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 470
Insurance Median: $20,068
Cash Discount Price: $67,194
vs. Medicare Baseline: 1.43x Medicare

The contracted insurance negotiated median rate for a Hip or knee replacement (inpatient stay) at Island Hospital is $20,068. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $67,194. Compared to the federal Medicare reimbursement reference rate of $14,044.15, this hospital’s rate is 1.43x the Medicare baseline. Located in 1211 24Th Street, Anacortes, WA.

Cash / Self-Pay

$67,194

Average discount available for prompt cash payment at this facility.

Insurance Median

$20,068

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: $67,194 (478%)

Insurance Median: $20,068 (143%)

Cash: $67,194 (478% of Medicare)

Ins. Median: $20,068 (143% 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
Premera Comm - All Other Plans	$13,059	93%
Aarp Mcr Adv - All Plans	$14,789	105%
Kaiser Mcr Adv	$14,789	105%
Samish Indian Health - All Plans	$14,789	105%
Swinomish Indian Health - All Plans	$14,789	105%
Tricare	$14,789	105%
UnitedHealthcare	$14,789 - $17,000	105%
Aetna	$15,529 - $63,835	111%
Humana	$15,529 - $57,115	111%
Premera Mcr Adv	$15,529	111%
Regence Mcr Adv	$15,677	112%
Kaiser Comm - All Other Plans	$23,135	165%
Molina Mcaid - All Plans	$23,518	167%
Amerigroup Mcaid - All Plans	$24,694	176%
Chpw Mcaid - All Plans	$25,870	184%
Coordinated Care Mcaid - All Plans	$27,046	193%
First Choice - All Plans	$47,036	335%
Regence Comm - All Other Plans	$50,396	359%
Cigna	$53,756	383%
First Health - All Plans	$57,115	407%
Multiplan - All Plans	$57,115	407%

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 $67,194.
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 Island 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.