CMS Price Transparency Data

Hip or knee replacement (inpatient stay)

Facility: Thomas Jefferson University Hospital

Billing Code: 470 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 470
Insurance Median: $25,237
Cash Discount Price: $23,104
vs. Medicare Baseline: 1.80x Medicare

The contracted insurance negotiated median rate for a Hip or knee replacement (inpatient stay) at Thomas Jefferson University Hospital is $25,237. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $23,104. Compared to the federal Medicare reimbursement reference rate of $14,044.15, this hospital’s rate is 1.80x the Medicare baseline. Located in 111 South 11Th Street, Philadelphia, PA.

Cash / Self-Pay

$23,104

Average discount available for prompt cash payment at this facility.

Insurance Median

$25,237

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: $23,104 (165%)

Insurance Median: $25,237 (180%)

Cash: $23,104 (165% of Medicare)

Ins. Median: $25,237 (180% 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
Medicare (plans)	$14,844 - $23,218	106%
Aetna	$19,070 - $54,883	136%
Jefferson Health Plan Aca Qhp Exchange	$19,370	138%
Inspira Life	$20,189	144%
Point Of Comfort Refugee Resettlement	$20,189	144%
St Agnes	$20,189	144%
Tricare	$20,189	144%
UnitedHealthcare	$20,189 - $21,804	144%
Humana	$20,593	147%
Innovage	$20,593	147%
Cigna	$20,997 - $55,467	150%
Keystone First Vip Choice	$20,997	150%
Ambetter / Centene	$21,184	151%
Devoted Health Participation	$21,199	151%
Provider Partners Health Plan	$21,602	154%
Allwell Pa Health_Wellness Ma	$22,208	158%
Highmark Wholecare Gateway	$22,208	158%
Perennial	$23,420	167%
Ibc Employee Benefit	$25,236	180%
Ibc Main Line Health	$25,236	180%
Naphcare	$25,421 - $32,303	181%
Blue Cross Blue Shield	$32,903 - $49,200	234%
Ibc	$32,931 - $62,819	234%
Highmark	$35,414 - $43,879	252%
Qualcare Jcc	$41,945 - $78,162	299%
Upmc Commercial	$55,467	395%
Geisinger Health Plan	$67,278	479%

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 $23,104.
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 Thomas Jefferson University 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.