CMS Price Transparency Data

Hip or knee replacement (inpatient stay)

Facility: Jefferson Abington Hospital

Billing Code: 470 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 470
Insurance Median: $19,256
Cash Discount Price: $17,550
vs. Medicare Baseline: 1.37x Medicare

The contracted insurance negotiated median rate for a Hip or knee replacement (inpatient stay) at Jefferson Abington Hospital is $19,256. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $17,550. Compared to the federal Medicare reimbursement reference rate of $14,044.15, this hospital’s rate is 1.37x the Medicare baseline. Located in 1200 Old York Road, Abington, PA.

Cash / Self-Pay

$17,550

Average discount available for prompt cash payment at this facility.

Insurance Median

$19,256

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: $17,550 (125%)

Insurance Median: $19,256 (137%)

Cash: $17,550 (125% of Medicare)

Ins. Median: $19,256 (137% 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)	$13,920 - $17,716	99%
Jefferson Health Plan Aca Qhp Exchange	$15,103	108%
Inspira Life	$15,405	110%
Point Of Comfort Refugee Resettlement	$15,405	110%
St Agnes	$15,405	110%
Tricare	$15,405	110%
UnitedHealthcare	$15,405 - $27,768	110%
Humana	$15,713	112%
Innovage	$15,713	112%
Aetna	$16,329 - $30,036	116%
Keystone First Vip Choice	$16,329	116%
Allwell Pa Health_Wellness Ma	$16,945	121%
Highmark Wholecare Gateway	$16,945	121%
Perennial	$17,870	127%
Ibc Employee Benefit	$19,256	137%
Ibc Main Line Health	$19,256	137%
Ibc	$19,623 - $32,023	140%
Ambetter / Centene	$20,188	144%
Naphcare	$24,648	176%
Blue Cross Blue Shield	$26,148 - $28,160	186%
Highmark	$26,833 - $33,248	191%
Cigna	$30,100 - $36,121	214%
Upmc Commercial	$36,121	257%
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 $17,550.
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 Jefferson Abington 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.