CMS Price Transparency Data

Hip or knee replacement (inpatient stay)

Facility: Lancaster General Hospital

Billing Code: 470 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 470
Insurance Median: $15,380
Cash Discount Price: Unavailable
vs. Medicare Baseline: 1.10x Medicare

The contracted insurance negotiated median rate for a Hip or knee replacement (inpatient stay) at Lancaster General Hospital is $15,380. 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 1.10x the Medicare baseline. Located in 555 North Duke Street, Lancaster, PA.

Cash / Self-Pay

Unavailable

Average discount available for prompt cash payment at this facility.

Insurance Median

$15,380

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: $15,380 (110%)

Ins. Median: $15,380 (110% 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
Gift Of Life Donor Program	$13,500	96%
Highmark	$14,404 - $38,669	103%
Albright Life	$14,832	106%
Coatesville Va	$14,832	106%
Lebanon Veterans Hospital	$14,832	106%
UnitedHealthcare	$14,832	106%
Aetna	$14,981 - $54,490	107%
Blue Cross Blue Shield	$15,055 - $24,841	107%
Amerihealth Caritas	$15,129	108%
Cigna	$15,277 - $38,881	109%
Health Partners Mcr Advantage	$15,277	109%
Medicare (plans)	$15,361 - $16,316	109%
Devoted Health	$15,574	111%
Pa Health And Wellness Mcr	$15,574	111%
Elap Employees	$21,812	155%
Oscar Health Plan	$28,923	206%
Claim Watcher Plus	$29,071	207%
Medicaid / KanCare	$29,993	214%
Highmark Commercial Preferred	$31,078	221%
Claim Watcher	$32,631	232%
Highmark Commercial Non-Preferred	$46,890	334%
Elap Other Groups	$50,691	361%

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 Lancaster General 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.