Hip or knee replacement (inpatient stay)
Facility: Sisters of Charity Hospital
Billing Code: 470 (MS-DRG)
- CPT Billing Code: 470
- Insurance Median: $14,030
- Cash Discount Price: $54,605
- vs. Medicare Baseline: 1.00x 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 |
|---|---|---|
| Beacon Essential [350122] | $11,329 - $11,443 | 81% |
| Beacon Health Options Alt [100024] | $11,329 | 81% |
| Medicaid / KanCare | $11,329 - $14,784 | 81% |
| Beacon Health Options [100023] | $11,329 | 81% |
| Molina Essential [100167] | $12,292 | 88% |
| UnitedHealthcare | $12,292 - $34,798 | 88% |
| Crime Victims [100176] | $12,292 | 88% |
| Blue Cross Blue Shield | $12,292 - $40,137 | 88% |
| Amerigroup [350102] | $12,292 | 88% |
| Univera Healthcare Essential [100170] | $12,292 | 88% |
| Excellus Rochester McD [350117] | $12,292 | 88% |
| Fidelis Essential [100163] | $12,292 | 88% |
| Independent Health Essential [100166] | $12,292 - $14,751 | 88% |
| Wellcare Fidelis Dual [450451] | $14,030 | 100% |
| Aetna | $14,030 | 100% |
| Federal Workers Compensation [500100] | $14,030 | 100% |
| Fidelis Dual Advantage [450120] | $14,030 | 100% |
| Cigna | $14,030 | 100% |
| Seneca Nation [450119] | $14,030 | 100% |
| Wellcare [450129] | $14,030 | 100% |
| Humana | $14,030 | 100% |
| Fallon Health [450115] | $14,030 | 100% |
| VA Veterans Affairs [700001] | $14,030 - $17,717 | 100% |
| Covid19 Hrsa [45013] | $14,030 | 100% |
| Medicare (plans) | $14,030 | 100% |
| Workers Compensation [500101] | $17,347 | 124% |
| No Fault [114001] | $17,347 | 124% |
| Tricare | $17,717 | 126% |
| Champ VA [700002] | $17,717 | 126% |
| Fidelis Exchange [100164] | $18,709 | 133% |
| Mvp Healthcare [100168] | $19,126 | 136% |
| Independent Health [100165] | $24,086 - $37,578 | 172% |
| Univera Healthcare [100169] | $24,837 - $35,483 | 177% |
| Iha First Choice [800001] | $29,676 | 211% |
| UPMC Health Plan [100181] | $32,804 | 234% |
| Ghi [100153] | $36,053 | 257% |