CMS Price Transparency Data

Hip or knee replacement (inpatient stay)

Facility: Lower Bucks Hospital

Billing Code: 470 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 470
Insurance Median: $17,743
Cash Discount Price: $17,226
vs. Medicare Baseline: 1.26x Medicare

The contracted insurance negotiated median rate for a Hip or knee replacement (inpatient stay) at Lower Bucks Hospital is $17,743. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $17,226. Compared to the federal Medicare reimbursement reference rate of $14,044.15, this hospital’s rate is 1.26x the Medicare baseline. Located in 501 Bath Road, Bristol, PA.

Cash / Self-Pay

$17,226

Average discount available for prompt cash payment at this facility.

Insurance Median

$17,743

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: $17,226 (123%)

Insurance Median: $17,743 (126%)

Cash: $17,226 (123% of Medicare)

Ins. Median: $17,743 (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
Keenan	$7,650	54%
Blue Cross Blue Shield	$15,538 - $25,058	111%
Health Partners Plan	$15,538 - $23,841	111%
Pa Health & Wellness	$15,538 - $20,672	111%
UnitedHealthcare	$15,538 - $24,788	111%
Humana	$16,090	115%
Keystone	$16,160	115%
Medicare (plans)	$16,315 - $17,226	116%
Provider Patners Health Plan	$17,743	126%
Spartan Plan Pa	$18,088	129%
Auto Insurance	$18,949	135%
Employer Direct Healthcare	$22,394	159%
Tricare	$23,175	165%
Cigna	$25,265	180%
Highmark	$32,795	234%

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 $17,226.
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 Lower Bucks 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.