CMS Price Transparency Data

Hip or knee replacement (inpatient stay)

Facility: Saint Francis Hospital-Evanston

Billing Code: 470 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 470
Insurance Median: $17,724
Cash Discount Price: $19,798
vs. Medicare Baseline: 1.26x Medicare

The contracted insurance negotiated median rate for a Hip or knee replacement (inpatient stay) at Saint Francis Hospital-Evanston is $17,724. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $19,798. Compared to the federal Medicare reimbursement reference rate of $14,044.15, this hospital’s rate is 1.26x the Medicare baseline. Located in 355 Ridge Ave, Evanston, IL.

Cash / Self-Pay

$19,798

Average discount available for prompt cash payment at this facility.

Insurance Median

$17,724

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: $19,798 (141%)

Insurance Median: $17,724 (126%)

Cash: $19,798 (141% of Medicare)

Ins. Median: $17,724 (126% 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
Blue Cross Blue Shield	$15,663 - $27,718	112%
Aetna	$16,487 - $17,312	117%
Celtic (Wellcare)	$16,487	117%
Cigna	$16,487 - $22,182	117%
Devoted Health	$16,487	117%
Humana	$16,487 - $18,136	117%
Illinois Physicians Alliance	$16,487	117%
Longevity Health Plan Of Illinois	$16,487	117%
UnitedHealthcare	$16,487 - $19,799	117%
Clear Spring Health Of Illinois	$16,652	119%
Molina	$16,982 - $29,698	121%
Zing Health Provider Network	$16,982	121%
Meridian	$17,312	123%
Provider Partners Health Plan (Pphp)	$17,312	123%
Medicare (plans)	$19,799	141%
Self-Pay	$19,799	141%
Access Community Health Network	$23,759	169%
Tricare	$27,665	197%
Hfn Inc (Healthcare Finest Network)	$30,524	217%
Clifton Health Systems	$30,688	219%
Coventry	$31,180	222%
Workers Comp	$31,180	222%
Ambetter / Centene	$32,074	228%

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 $19,798.
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 Saint Francis Hospital-Evanston 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.