CMS Price Transparency Data

Hip or knee replacement (inpatient stay)

Facility: Connecticut Childrens Medical Center

Billing Code: 470 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 470
Insurance Median: $8,780
Cash Discount Price: $89,757
vs. Medicare Baseline: 0.63x Medicare

The contracted insurance negotiated median rate for a Hip or knee replacement (inpatient stay) at Connecticut Childrens Medical Center is $8,780. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $89,757. Compared to the federal Medicare reimbursement reference rate of $14,044.15, this hospital’s rate is 0.63x the Medicare baseline. Located in 282 Washington Street, Hartford, CT.

Cash / Self-Pay

$89,757

Average discount available for prompt cash payment at this facility.

Insurance Median

$8,780

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: $89,757 (639%)

Insurance Median: $8,780 (63%)

Cash: $89,757 (639% of Medicare)

Ins. Median: $8,780 (63% 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	$7,902 - $8,780	56%
Cigna	$8,345	59%
Great West Healthcare [100107]	$8,345	59%
Mvp Health Plan [100144]	$8,345	59%
Harvard Pilgrim [1001134]	$8,693 - $9,776	62%
Multiplan [1001126]	$8,693	62%
UnitedHealthcare	$8,693 - $10,535	62%
1199 National Benefit Fund [100134]	$8,780	63%
Government Employees Hospital Assoc [100115]	$8,780	63%
Humana	$8,780	63%
Meritain Health [100149]	$8,780	63%
Nippon Life Ins Co Of America [100112]	$8,780	63%
Yale Health Plan [100162]	$8,780	63%
Blue Cross Blue Shield	$9,119	65%
Unicare [100148]	$9,119	65%
Wellpoint [100150]	$9,119	65%
Connecticare [100105]	$9,588 - $10,535	68%
Golden Rule [100106]	$9,776	70%
Oxford [100103]	$9,776	70%
Emblem Health Commercial [1001108]	$10,535	75%

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 $89,757.
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 Connecticut Childrens 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.