CMS Price Transparency Data

Hip or knee replacement (inpatient stay)

Facility: Temple University Hospital

Billing Code: 470 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 470
Insurance Median: $25,936
Cash Discount Price: Unavailable
vs. Medicare Baseline: 1.85x Medicare

The contracted insurance negotiated median rate for a Hip or knee replacement (inpatient stay) at Temple University Hospital is $25,936. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is unavailable. Compared to the federal Medicare reimbursement reference rate of $14,044.15, this hospital’s rate is 1.85x the Medicare baseline. Located in 3401 North Broad Street, Philadelphia, PA.

Cash / Self-Pay

Unavailable

Average discount available for prompt cash payment at this facility.

Insurance Median

$25,936

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%)

Insurance Median: $25,936 (185%)

Ins. Median: $25,936 (185% 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	$21,614 - $81,673	154%
Humana	$21,614	154%
UnitedHealthcare	$21,614 - $45,157	154%
Innovage	$22,046	157%
Aetna	$22,262 - $44,890	159%
Cigna	$22,478 - $43,391	160%
Keystone First	$22,694	162%
Clover Health	$22,910	163%
Upmc Health Plan	$23,127	165%
Gateway Health Plan	$23,343	166%
Geisinger	$23,775 - $69,762	169%
Pennsylvania Health And Wellness	$23,775	169%
Health Partners Plans	$24,326	173%
Elder Health	$25,936	185%
Wtc Health Program	$28,817	205%
Prime Health Services	$29,818	212%
Naphcare	$32,420	231%
Oscar Health	$34,296	244%

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 $X.
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 Temple University Hospital 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.