Hip or knee replacement (inpatient stay)
Facility: St Francis Hospital - the Heart Center
Billing Code: 470 (MS-DRG)
- CPT Billing Code: 470
- Insurance Median: $17,022
- Cash Discount Price: Unavailable
- vs. Medicare Baseline: 1.21x Medicare
Average discount available for prompt cash payment at this facility.
Median negotiated contract rate across all mapped commercial carriers.
Standard federal government reimbursement rate for this code.
Visual Cost Comparison vs. 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.
Commercial Insurance Negotiated Rates
Negotiated contract ranges established by major commercial carriers at this facility.
| Carrier / Plan Group | Contract Rate Range | vs. Medicare Reference |
|---|---|---|
| Brighton | $9,878 - $12,625 | 70% |
| Blue Cross Blue Shield | $16,039 - $58,701 | 114% |
| Centerlight Healthcare | $16,039 | 114% |
| Centers Plan For Healthy Living | $16,367 | 117% |
| Elderplan Inc. | $16,367 | 117% |
| Emblem Health | $16,367 - $70,286 | 117% |
| Fidelis Care New York | $16,367 | 117% |
| Healthspring | $16,367 | 117% |
| Independent Health | $16,367 | 117% |
| Liberty Health | $16,367 | 117% |
| Longevity Health Plan | $16,367 | 117% |
| Medicare (plans) | $16,367 - $17,185 | 117% |
| Mvp Health Plans | $16,367 - $48,932 | 117% |
| Orthonet - Uniformed Services Family Health Plan | $16,367 | 117% |
| Pmc | $16,367 | 117% |
| Senior Whole Health | $16,367 | 117% |
| Tricare | $16,367 | 117% |
| UnitedHealthcare | $16,367 - $58,701 | 117% |
| Universal Healthcare | $16,367 | 117% |
| Veterans Affairs | $16,367 | 117% |
| Zadroga | $16,367 | 117% |
| Health First | $16,530 - $36,825 | 118% |
| Aetna | $16,624 - $59,033 | 118% |
| Health Plus | $16,624 | 118% |
| Humana | $16,694 | 119% |
| Agewell New York | $16,940 | 121% |
| Wellcare Health Plan Inc | $17,022 | 121% |
| Partners Health Plan | $17,185 | 122% |
| Us Family Health Plan | $17,613 | 125% |
| Local 1199 | $33,305 | 237% |
| Centivo | $41,343 - $48,932 | 294% |
| Apwu | $48,932 | 348% |
| Cigna | $48,932 | 348% |
| Daniel H Cook | $48,932 | 348% |
| Nalc | $48,932 | 348% |
| Samba | $48,932 | 348% |
| Surest | $58,296 | 415% |
| Self Pay | $58,701 | 418% |
| Mail Handlers Benefit Plan | $59,033 | 420% |
| Meritain Health | $59,033 | 420% |
| Nippon Life Insurance Company Of America | $59,033 | 420% |
| Salvation Army | $59,033 | 420% |
| American Plan Administrators | $70,286 | 500% |
| Amerihealth Administrators | $70,286 | 500% |
| Benefit Services | $70,286 | 500% |
| Ghi Cbp Ny City Employee Alternate | $70,286 | 500% |
| International Benefit Administrator | $70,286 | 500% |
| Ultra Benefits Inc. | $70,286 | 500% |