CMS Price Transparency Data

Hip or knee replacement (inpatient stay)

Facility: Milton S Hershey Medical Center

Billing Code: 470 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 470
Insurance Median: $21,296
Cash Discount Price: Unavailable
vs. Medicare Baseline: 1.52x Medicare

The contracted insurance negotiated median rate for a Hip or knee replacement (inpatient stay) at Milton S Hershey Medical Center is $21,296. 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 1.52x the Medicare baseline. Located in 500 University Drive, Hershey, PA.

Cash / Self-Pay

Unavailable

Average discount available for prompt cash payment at this facility.

Insurance Median

$21,296

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: $21,296 (152%)

Ins. Median: $21,296 (152% 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]	$20,670 - $38,428	147%
Aetna	$20,879 - $44,984	149%
[Amerihealth Caritas]	$20,879	149%
[Cbc]	$20,879 - $42,347	149%
[Geisinger]	$20,879	149%
[Highmark Wholecare]	$20,879	149%
Humana	$21,087	150%
[Healthspring]	$21,087	150%
UnitedHealthcare	$21,296 - $52,175	152%
[Health Partners Plans]	$21,296	152%
[Pa Health & Wellness]	$21,505	153%
[Upmc]	$21,925	156%
[Point Comfort Underwriters]	$26,098	186%
[Highmark Aca]	$26,900	192%
[Highmark Choice Blue]	$30,743	219%
Cigna	$52,944	377%

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 Milton S Hershey 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.