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Pennsylvania rates for MS-DRG 469

Major joint replacement or reattachment of lower extremity w MCC

Facilitymedian $50,119 · 10th–90th $27,542–$72,4440%10%10th90th$50,119$2.0K$10.0K$50.0K$200.0K

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$27,542.29 / $50,118.72 / $72,443.60
Capital Blue Cross
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$20,892.96 / $57,543.99 / $79,432.82
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$26,302.68 / $47,863.01 / $67,608.30
Emblem Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$53,703.18 / $53,703.18 / $64,565.42
Geisinger
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$21,877.62 / $50,118.72 / $61,659.50
Highmark BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$33,884.42 / $67,608.30 / $831,763.77
Martin's Point
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$27,542.29 / $46,773.51 / $70,794.58
UPMC Health Plan
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$22,387.21 / $24,547.09 / $28,183.83
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$5,623.41 / $38,018.94 / $70,794.58