Hip or knee replacement (inpatient stay)
Facility: Pennsylvania Hospital
Billing Code: 470 (MS-DRG)
- CPT Billing Code: 470
- Insurance Median: $22,110
- Cash Discount Price: Unavailable
- vs. Medicare Baseline: 1.57x Medicare
Average discount available for prompt cash payment at this facility.
Median negotiated contract rate across all mapped commercial carriers.
Standard federal government reimbursement rate for this code.
Visual Cost Comparison vs. 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.
Commercial Insurance Negotiated Rates
Negotiated contract ranges established by major commercial carriers at this facility.
| Carrier / Plan Group | Contract Rate Range | vs. Medicare Reference |
|---|---|---|
| Workers Compensation | $3,209 | 23% |
| UnitedHealthcare | $3,308 - $43,735 | 24% |
| Penn Life (Living Independently For Elders) | $7,452 | 53% |
| Us Family Health Plan | $9,660 | 69% |
| Ibc | $16,004 | 114% |
| Blue Cross Blue Shield | $16,173 - $45,100 | 115% |
| Medicare (plans) | $16,173 - $18,467 | 115% |
| Upmc | $16,173 | 115% |
| Cigna | $16,658 - $40,661 | 119% |
| Geisinger Health Plan | $16,658 - $58,146 | 119% |
| Health Partners | $16,658 | 119% |
| Humana | $16,658 | 119% |
| Keystone First | $16,981 | 121% |
| Pa Health And Wellness | $16,981 - $30,470 | 121% |
| Aetna | $17,143 - $34,524 | 122% |
| Clover Health Plan | $17,143 | 122% |
| Gateway Health Plan | $17,631 | 126% |
| Pgm - Embassy Of Qatar | $17,941 | 128% |
| Philadelphia Va Medical Center | $18,467 | 131% |
| Pgm - Embassy Of The United Emirates/Ipc | $19,321 | 138% |
| Elap | $26,223 | 187% |
| Ibc Commercial Hpn | $26,883 | 191% |
| Claims Watcher | $29,547 - $33,240 | 210% |
| Oscar Health Plan | $31,393 | 224% |
| Centivo | $33,240 | 237% |
| Elap Services | $34,348 | 245% |
| Highmark | $36,640 | 261% |
| Keystone Hmo Proactive | $36,740 | 262% |
| Olympus | $40,431 | 288% |
| Penn Global Medicine | $48,936 | 348% |
| Qualcare | $52,122 | 371% |