CMS Price Transparency Data

Hip or knee replacement (inpatient stay)

Facility: Lehigh Valley Hospital

Billing Code: 470 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 470
Insurance Median: $23,087
Cash Discount Price: Unavailable
vs. Medicare Baseline: 1.64x Medicare

The contracted insurance negotiated median rate for a Hip or knee replacement (inpatient stay) at Lehigh Valley Hospital is $23,087. 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 1.64x the Medicare baseline. Located in 1200 South Cedar Crest Boulevard, Allentown, PA.

Cash / Self-Pay

Unavailable

Average discount available for prompt cash payment at this facility.

Insurance Median

$23,087

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: $23,087 (164%)

Ins. Median: $23,087 (164% 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	$11,727 - $44,617	84%
Amerihealth	$16,363 - $16,854	117%
Ibc	$16,363	117%
UnitedHealthcare	$16,363 - $33,234	117%
Highmark Blue Shield	$16,690 - $35,825	119%
Cigna	$16,854 - $71,567	120%
Geisinger	$16,854 - $41,018	120%
Pa Health & Wellness (Allwell)	$16,854	120%
Aetna	$17,181 - $42,096	122%
Gateway	$17,181	122%
Jefferson Health Partners	$17,181 - $30,047	122%
Devoted Health	$17,345	124%
Humana	$17,345	124%
Upmc	$17,345 - $40,386	124%
Emblem	$17,672 - $29,425	126%
Populytics	$17,779	127%
Valley Preferred	$37,488	267%
Ambetter / Centene	$37,718	269%

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 Lehigh Valley 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.