CMS Price Transparency Data

Hip or knee replacement (inpatient stay)

Facility: Lehigh Valley Hospital - Hazleton

Billing Code: 470 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 470
Insurance Median: $17,893
Cash Discount Price: Unavailable
vs. Medicare Baseline: 1.27x Medicare

The contracted insurance negotiated median rate for a Hip or knee replacement (inpatient stay) at Lehigh Valley Hospital - Hazleton is $17,893. 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 1.27x the Medicare baseline. Located in 700 East Broad Street, Hazleton, PA.

Cash / Self-Pay

Unavailable

Average discount available for prompt cash payment at this facility.

Insurance Median

$17,893

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: $17,893 (127%)

Ins. Median: $17,893 (127% 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
Highmark Blue Shield	$13,567 - $25,813	97%
Geisinger	$14,093 - $31,170	100%
Amerihealth	$14,231	101%
Cigna	$14,231 - $22,532	101%
Pa Health & Wellness (Allwell)	$14,231	101%
UnitedHealthcare	$14,370 - $33,234	102%
Aetna	$14,508 - $32,221	103%
Gateway	$14,508	103%
Jefferson Health Partners	$14,508 - $24,576	103%
Devoted Health	$14,646	104%
Humana	$14,646	104%
Upmc	$14,646 - $30,931	104%
Emblem	$14,922 - $29,425	106%
Ambetter / Centene	$31,849	227%
Valley Preferred	$37,488	267%

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 - Hazleton 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.