CMS Price Transparency Data

Hip or knee replacement (inpatient stay)

Facility: Penn Presbyterian Medical Center

Billing Code: 470 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 470
Insurance Median: $20,623
Cash Discount Price: Unavailable
vs. Medicare Baseline: 1.47x Medicare

The contracted insurance negotiated median rate for a Hip or knee replacement (inpatient stay) at Penn Presbyterian Medical Center is $20,623. 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 1.47x the Medicare baseline. Located in 51 North 39Th Street, Philadelphia, PA.

Cash / Self-Pay

Unavailable

Average discount available for prompt cash payment at this facility.

Insurance Median

$20,623

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: $20,623 (147%)

Ins. Median: $20,623 (147% 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
UnitedHealthcare	$3,121 - $43,735	22%
Penn Life (Living Independently For Elders)	$7,452	53%
Us Family Health Plan	$9,660	69%
Blue Cross Blue Shield	$16,321 - $44,003	116%
Medicare (plans)	$16,321 - $20,181	116%
Upmc	$16,321	116%
Ibc	$16,363	117%
Cigna	$16,811 - $40,661	120%
Geisinger Health Plan	$16,811 - $27,601	120%
Health Partners	$16,811	120%
Humana	$16,811	120%
Keystone First	$17,137	122%
Pa Health And Wellness	$17,137 - $33,299	122%
Aetna	$17,300 - $38,178	123%
Clover Health Plan	$17,300	123%
Gateway Health Plan	$17,792	127%
Pgm - Embassy Of Qatar	$17,941	128%
Pgm - Embassy Of The United Emirates/Ipc	$19,321	138%
Philadelphia Va Medical Center	$20,181	144%
Workers Compensation	$27,601	197%
Elap	$28,657	204%
Ibc Commercial Hpn	$31,564	225%
Claims Watcher	$32,290 - $36,326	230%
Oscar Health Plan	$34,308	244%
Centivo	$36,326	259%
Elap Services	$37,537	267%
Keystone Hmo Proactive	$38,064	271%
Olympus	$40,802	291%
Highmark	$41,791	298%
Qualcare	$52,122	371%
Penn Global Medicine	$53,480	381%

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 Penn Presbyterian Medical Center 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.