CMS Price Transparency Data

Hip or knee replacement (inpatient stay)

Facility: Swedish Issaquah

Billing Code: 470 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 470
Insurance Median: $27,455
Cash Discount Price: Unavailable
vs. Medicare Baseline: 1.95x Medicare

The contracted insurance negotiated median rate for a Hip or knee replacement (inpatient stay) at Swedish Issaquah is $27,455. 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 1.95x the Medicare baseline. Located in 751 Ne Blakely Dr, Issaquah, WA.

Cash / Self-Pay

Unavailable

Average discount available for prompt cash payment at this facility.

Insurance Median

$27,455

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: $27,455 (195%)

Ins. Median: $27,455 (195% 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
Kaiser	$17,159 - $25,739	122%
Molina	$17,159 - $18,532	122%
Aetna	$17,674 - $17,846	126%
Blue Cross Blue Shield	$17,846 - $39,474	127%
Providence Health Plan	$17,846 - $36,106	127%
UnitedHealthcare	$18,017 - $59,288	128%
Humana	$18,189	130%
Blue Shield	$18,532 - $40,242	132%
Amerigroup	$18,875	134%
Community Health Plan Of Washington	$18,875	134%
Cigna	$20,591 - $53,505	147%
Community Health Plan	$27,455	195%
Coordinated Care	$27,455 - $31,744	195%
First Choice	$48,783 - $49,776	347%

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 Issaquah 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.