CMS Price Transparency Data
Hip or knee replacement (inpatient stay)
Facility: Physicians Care Surgical Hospital
Billing Code: 470 (MS-DRG)
Factual Cost Summary (Answer Capsule)
- CPT Billing Code: 470
- Insurance Median: $18,753
- Cash Discount Price: $10,218
- vs. Medicare Baseline: 1.34x Medicare
The contracted insurance negotiated median rate for a Hip or knee replacement (inpatient stay) at Physicians Care Surgical Hospital is $18,753. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $10,218. Compared to the federal Medicare reimbursement reference rate of $14,044.15, this hospital’s rate is 1.34x the Medicare baseline. Located in 454 Enterprise Drive, Royersford, PA.
Cash / Self-Pay
$10,218
Average discount available for prompt cash payment at this facility.
Insurance Median
$18,753
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: $10,218 (73%)
Insurance Median: $18,753 (134%)
Cash: $10,218 (73% of Medicare)
Ins. Median: $18,753 (134% 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.
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Commercial Insurance Negotiated Rates
Negotiated contract ranges established by major commercial carriers at this facility.
| Carrier / Plan Group | Contract Rate Range | vs. Medicare Reference |
|---|---|---|
| Keystone First | $2,850 | 20% |
| Keystone First Healthplan | $2,850 | 20% |
| Keystone First Vip Choice | $2,850 | 20% |
| Medicaid / KanCare | $2,850 | 20% |
| Pa Health And Wellness | $2,850 | 20% |
| Straight Access | $2,850 | 20% |
| Ibc Security 65 | $12,363 | 88% |
| Medicare (plans) | $12,363 - $12,772 | 88% |
| Personal Choice 65 | $12,363 | 88% |
| Aarp | $12,772 | 91% |
| Aetna | $12,772 - $23,230 | 91% |
| Blue Cross Blue Shield | $12,772 - $23,941 | 91% |
| Cigna | $12,772 - $18,977 | 91% |
| Devon Health Services | $12,772 | 91% |
| Gpm Health And Life Insurance Mc Supplement | $12,772 | 91% |
| Humana | $12,772 | 91% |
| Keystone 65 Hmo | $12,772 | 91% |
| Pcsh Aarp | $12,772 | 91% |
| Shenandoah Life | $12,772 | 91% |
| Tricare | $12,772 | 91% |
| Unified Health Services | $12,772 | 91% |
| UnitedHealthcare | $12,772 - $27,099 | 91% |
| Vibra Health Plan | $12,772 | 91% |
| Amerihealth Administrators | $18,753 | 134% |
| Amerihealth New Jersey Hmo | $18,753 | 134% |
| Carefirst Administrators | $18,753 | 134% |
| Empire Plan | $18,753 | 134% |
| Horizon Of New Jersey | $18,753 | 134% |
| Ibc | $18,753 | 134% |
| Ibc - Local | $18,753 | 134% |
| Ibc 2021 | $18,753 | 134% |
| Ibc Local | $18,753 | 134% |
| Independence Administrators | $18,753 | 134% |
| Independence Bc | $18,753 | 134% |
| Independence Federal | $18,753 | 134% |
| Keystone Direct Pos | $18,753 | 134% |
| Keystone Healthplan East | $18,753 | 134% |
| Keystone Hmo | $18,753 | 134% |
| Pcsh Ibc | $18,753 | 134% |
| Personal Choice | $18,753 | 134% |
| Regence Blue Shield | $18,753 | 134% |
| Apwu | $18,977 | 135% |
| Cwi Benefits | $18,977 | 135% |
| Freedom Life Insurance Company | $18,977 | 135% |
| Health Partners | $18,977 | 135% |
| Healthgram | $18,977 | 135% |
| Loomis | $18,977 | 135% |
| Nalc Health | $18,977 | 135% |
| Sana Benefits | $18,977 | 135% |
| Upmc | $19,295 | 137% |
| Connecticare | $19,575 | 139% |
| Central Pa Teamsters | $21,231 | 151% |
| Ag Administrators | $23,230 | 165% |
| Ag Administrators Inc | $23,230 | 165% |
| Allied Benefit Systems | $23,230 | 165% |
| Allied Benefits Systems | $23,230 | 165% |
| Continental Benefits | $23,230 | 165% |
| Coventry | $23,230 | 165% |
| Geha | $23,230 | 165% |
| Healthez | $23,230 | 165% |
| Lucent Health | $23,230 | 165% |
| Marpai Health | $23,230 | 165% |
| Meritain Health | $23,230 | 165% |
| Premier Care Network | $23,230 | 165% |
| Trustmark | $23,230 | 165% |
| Highmark | $23,941 | 170% |
| Allsavers | $27,099 | 193% |
| Golden Rule Op | $27,099 | 193% |
| Oxford Health Plan | $27,099 | 193% |
| Oxford Life Insurance Company | $27,099 | 193% |
| Surest | $27,099 | 193% |