CMS Price Transparency Data

Hip or knee replacement (inpatient stay)

Facility: UPMC Hamot

Billing Code: 470 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 470
Insurance Median: $18,605
Cash Discount Price: Unavailable
vs. Medicare Baseline: 1.32x Medicare

The contracted insurance negotiated median rate for a Hip or knee replacement (inpatient stay) at UPMC Hamot is $18,605. 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 1.32x the Medicare baseline. Located in 201 State Street, Erie, PA.

Cash / Self-Pay

Unavailable

Average discount available for prompt cash payment at this facility.

Insurance Median

$18,605

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: $18,605 (132%)

Ins. Median: $18,605 (132% 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
Upmc Work Partners	$9,495	68%
Blue Cross Blue Shield	$17,308 - $38,120	123%
Fidelis	$17,308	123%
Independent Health	$17,524	125%
UnitedHealthcare	$17,630 - $18,520	126%
Aetna	$17,654	126%
Wellcare	$17,827	127%
Highmark Wholecare (Prev Gateway)	$18,691	133%
Amerihealth Caritas	$18,693	133%
Cigna	$18,693	133%
Pa Health & Wellness	$18,693	133%
Upmc Health Plan	$18,938 - $20,424	135%
Univera	$19,039	136%

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 UPMC Hamot 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.