CMS Price Transparency Data

Hip or knee replacement (inpatient stay)

Facility: Jefferson Healthcare

Billing Code: 470 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 470
Insurance Median: $76,771
Cash Discount Price: $97,759
vs. Medicare Baseline: 5.47x Medicare

The contracted insurance negotiated median rate for a Hip or knee replacement (inpatient stay) at Jefferson Healthcare is $76,771. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $97,759. Compared to the federal Medicare reimbursement reference rate of $14,044.15, this hospital’s rate is 5.47x the Medicare baseline. Located in 834 Sheridan Street, Port Townsend, WA.

Cash / Self-Pay

$97,759

Average discount available for prompt cash payment at this facility.

Insurance Median

$76,771

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: $97,759 (696%)

Insurance Median: $76,771 (547%)

Cash: $97,759 (696% of Medicare)

Ins. Median: $76,771 (547% 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 547% of the Medicare baseline (a markup of 447%). 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
Tricare	$13,974	100%
Aetna	$16,440 - $109,979	117%
Molina Mcr Adv	$16,440	117%
Medicare (plans)	$16,769	119%
Chpw Mcr Adv	$17,755	126%
Molina Marketplace-All Other Plans	$20,550	146%
UnitedHealthcare	$22,872	163%
Chpw Mcaid	$75,666	539%
Molina Mcaid	$75,666	539%
Amerigroup Mcaid-All Plans	$77,877	555%
Coord Care Mcaid Ip/Op Only	$79,344	565%
Regence-All Other Plans	$91,649	653%
Chpw Commercial-All Other Plans	$103,869	740%
Premera-All Plans	$103,869	740%
Cigna	$109,979	783%
Coord Care Cascade Ip/Op Only	$109,979	783%
Coord Care Comm/Exchge-All Other Plans	$109,979	783%

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 $97,759.
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 Jefferson Healthcare 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.