CMS Price Transparency Data

Hip or knee replacement (inpatient stay)

Facility: Reading Hospital

Billing Code: 470 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 470
Insurance Median: $15,731
Cash Discount Price: Unavailable
vs. Medicare Baseline: 1.12x Medicare

The contracted insurance negotiated median rate for a Hip or knee replacement (inpatient stay) at Reading Hospital is $15,731. 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 1.12x the Medicare baseline. Located in 420 S 5Th Avenue, West Reading, PA.

Cash / Self-Pay

Unavailable

Average discount available for prompt cash payment at this facility.

Insurance Median

$15,731

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: $15,731 (112%)

Ins. Median: $15,731 (112% 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
Humana	$12,615 - $15,583	90%
UnitedHealthcare	$12,615 - $65,583	90%
Highmark	$14,689 - $70,139	105%
Upmc	$14,841 - $15,731	106%
Blue Cross Blue Shield	$15,243 - $46,557	109%
Geisinger	$15,271 - $38,578	109%
Amerihealth Caritas	$15,286	109%
Health America	$15,434	110%
Devoted Health	$15,583	111%
Health Partners	$15,583	111%
Pa Health & Wellness	$15,583 - $25,670	111%
Senior Life	$16,028	114%
Aetna	$16,325 - $53,903	116%
Cigna	$35,646	254%
First Health	$59,293	422%
Gateway	$59,293	422%

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 Reading 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.