Hip or knee replacement (inpatient stay)
Facility: Ann & Robert H Lurie Childrens Hospital of Chicago
Billing Code: 470 (MS-DRG)
- CPT Billing Code: 470
- Insurance Median: $183,051
- Cash Discount Price: $160,170
- vs. Medicare Baseline: 13.03x 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.
Elevated Commercial Rate Alert (Value-Gap)
The negotiated rate at this facility is 1303% of the Medicare baseline (a markup of 1203%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.
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 |
|---|---|---|
| Medicare (plans) | $2,656 | 19% |
| Unicare | $3,678 | 26% |
| Mercycare Health | $84,661 | 603% |
| Cigna | $96,102 - $162,458 | 684% |
| Aetna | $114,407 - $121,271 | 815% |
| La Rabida Childrens Hospital | $114,407 | 815% |
| Centegra | $137,288 | 978% |
| Independent Physicians at Mercy | $137,288 | 978% |
| Blue Cross Blue Shield | $137,288 - $183,051 | 978% |
| Imagine Health | $160,170 | 1140% |
| St. Francis | $160,170 | 1140% |
| West Suburban Health Providers | $160,170 | 1140% |
| Advanced Physicians Association IPA | $160,170 | 1140% |
| Methodist First Choice | $160,170 | 1140% |
| Ui Health | $160,170 | 1140% |
| Northwest Community Healthcare | $160,170 | 1140% |
| Health Plus | $160,170 | 1140% |
| Swedish Covenant Physician Partners | $171,610 | 1222% |
| Shriners Hospital | $171,610 | 1222% |
| American Psych Systems | $183,051 | 1303% |
| Health Alliance | $183,051 | 1303% |
| Macneal Health | $183,051 | 1303% |
| Healthlink Inc. | $188,771 | 1344% |
| Hfn Inc | $194,492 - $205,932 | 1385% |
| Cofinity | $194,492 | 1385% |
| Humana | $194,492 | 1385% |
| Principal Healthcare | $194,492 | 1385% |
| St. Elizabeth | $194,492 | 1385% |
| Sagamore Health Network | $201,356 | 1434% |
| Preferred Health Network | $201,356 | 1434% |
| Healthstar | $201,356 | 1434% |
| First Health | $201,356 | 1434% |
| Beech Street | $205,932 | 1466% |
| Benchmark Health | $205,932 | 1466% |
| Employer's Coalition on Health | $205,932 | 1466% |
| Security Health Plan | $205,932 | 1466% |
| Swedish American | $205,932 | 1466% |
| Private Health Care System | $205,932 | 1466% |
| Wellmark/Healthnetwork | $210,509 | 1499% |
| Integrated Health Plan | $217,373 | 1548% |
| Wea Insurance Group | $217,373 | 1548% |
| Multiplan | $217,373 | 1548% |
| National Provider Network | $217,373 | 1548% |