CMS Price Transparency Data

Hip or knee replacement (inpatient stay)

Facility: Swedish Medical Center

Billing Code: 470 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 470
Insurance Median: $32,720
Cash Discount Price: Unavailable
vs. Medicare Baseline: 2.33x Medicare

The contracted insurance negotiated median rate for a Hip or knee replacement (inpatient stay) at Swedish Medical Center is $32,720. 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 2.33x the Medicare baseline. Located in 747 Broadway, Seattle, WA.

Cash / Self-Pay

Unavailable

Average discount available for prompt cash payment at this facility.

Insurance Median

$32,720

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: $32,720 (233%)

Ins. Median: $32,720 (233% 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 233% of the Medicare baseline (a markup of 133%). 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
Humana	$19,522 - $20,693	139%
Kaiser	$19,522 - $29,282	139%
Molina	$19,522 - $21,083	139%
Aetna	$19,872 - $24,076	141%
Blue Cross Blue Shield	$20,302 - $45,368	145%
Providence Health Plan	$20,302 - $34,205	145%
UnitedHealthcare	$20,498 - $59,288	146%
Blue Shield	$21,083 - $40,995	150%
Amerigroup	$21,474	153%
Community Health Plan Of Washington	$21,474	153%
Cigna	$23,426 - $53,505	167%
Community Health Plan	$31,234	222%
Coordinated Care	$31,234 - $36,115	222%
Blue Shield-Ballard	$40,242 - $65,349	287%
Blue Shield-First Hill	$40,242 - $65,349	287%
Blue Shield-Mill Creek	$40,242 - $65,349	287%
Blue Shield-Redmond	$40,242 - $65,349	287%
First Choice	$55,202 - $58,250	393%

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 Swedish Medical Center 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.