CMS Price Transparency Data

Hip or knee replacement (inpatient stay)

Facility: Mt Sinai Hospital Medical Center

Billing Code: 470 (MS-DRG)

The BaseRate · fair price high confidence

A fair price for this

$17,424

about 1.2× the $14,044 Medicare rate · typically $14,428–$21,295

modeled estimate · not a bill or quote

What this hospital charges insurers

$19,757

About the fair price

about $2,333 over the fair price · 1.4× Medicare

Medicare pays $14,044 Fair price $17,424 This hospital $19,757 Cash price $57,641 Hospital's list price $82,344

How we calculate the fair BaseRate →

How this hospital compares to other IL hospitals

Highest price of the 9 IL hospitals we have prices for — worth calling around.

Cheapest $12,226 Priciest $19,757

Black dot = this hospital, among the 9 IL hospitals with a price for this procedure. Full list below.

A fair price for a Hip or knee replacement (inpatient stay) is about $17,424 (about 1.2× the $14,044 Medicare rate). Mt Sinai Hospital Medical Center charges insurers about $19,757, or about $57,641 in cash — about the fair price. Located in Chicago, IL.

What each insurance company pays

Which insurers have negotiated a price with this hospital for this procedure — and which haven’t.

5 of 6 major insurers have a published price at this hospital

✓ UnitedHealthcare✓ Blue Cross Blue Shield✓ Aetna✓ Cigna✓ Humana Kaiser Permanente

Crossed out = this hospital hasn’t published a negotiated price for that insurer for this procedure. It doesn’t necessarily mean they aren’t accepted — ask your insurer.

Insurance company	Price range	vs. Medicare
UnitedHealthcaremajor	$17,891 - $117,013	127%
Blue Cross Blue Shieldmajor	$19,323 - $29,223	138%
Aetnamajor	$28,469	203%
Cignamajor	$19,165 - $24,029	136%
Humanamajor	$19,757 - $40,963	141%
Ambetter (Centene)	$20,745 - $21,733	148%
Health Net	$19,165	136%
HealthLink	$47,062	335%
Meridian	$19,757	141%
Molina	$19,757 - $20,745	141%
Oscar Health	$18,304	130%
+ 11 smaller / regional plans	$14,570 - $49,406

Government programs also on file: Military & VA.

Excludes 6 rental-network / third-party entries (e.g. Multiplan, PHCS) — these are pricing networks, not insurers.

Self-Pay How to get the cash price

Tell the billing desk you want to be billed as self-pay — not through insurance — before your visit.
Ask for the cash / prompt-pay discount in writing, with the exact price (about 57,641), before you agree to anything.
Get it in writing that they won’t also bill your insurance, so the cash price is what you owe.
Check the MS-DRG code on your bill matches exactly: 470.

Insurance Before you use insurance

Call your insurance company to confirm Mt Sinai Hospital Medical Center is in-network.
Ask your insurer whether prior approval is required for MS-DRG code 470.
Confirm the doctor or provider is in-network too — not just the hospital building.
Check your Explanation of Benefits against the hospital’s final itemized bill.

Estimate your out-of-pocket cost

A rough estimate of what you’d pay with insurance (deductible + coinsurance) versus paying the cash price yourself.

How you’d pay

Deductible left to meet ($)

Your coinsurance (%)

Enter your details and press estimate to compare.

Other Procedures at Mt Sinai Hospital Medical Center

Compare: Hip or knee replacement (inpatient stay) at other IL hospitals

Blessing Hospital · Quincy $12,226
Alexian Brothers Medical Center 1 · Elk Grove Village $12,827
St Alexius Medical Center · Hoffman Estates $13,048
University of Illinois Hospital and Clinics · Chicago $13,087
Crawford Memorial Hospital · Robinson $13,322
Northwestern Medicine Delnor Community Hospital · Geneva $14,316
Edward Hospital · Naperville $14,765
Northwest Community Hospital 1 · Arlington Heights $14,777

Insurance negotiated median for the same procedure, sorted lowest first.