CMS Price Transparency Data

Hip or knee replacement (inpatient stay)

Facility: St Peter's Hospital

Billing Code: 470 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 470
Insurance Median: $20,197
Cash Discount Price: $32,697
vs. Medicare Baseline: 1.44x Medicare

The contracted insurance negotiated median rate for a Hip or knee replacement (inpatient stay) at St Peter's Hospital is $20,197. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $32,697. Compared to the federal Medicare reimbursement reference rate of $14,044.15, this hospital’s rate is 1.44x the Medicare baseline. Located in 315 South Manning Boulevard, Albany, NY.

Cash / Self-Pay

$32,697

Average discount available for prompt cash payment at this facility.

Insurance Median

$20,197

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: $32,697 (233%)

Insurance Median: $20,197 (144%)

Cash: $32,697 (233% of Medicare)

Ins. Median: $20,197 (144% 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
Wellpath	$3,000	21%
Blue Cross Blue Shield	$17,672 - $18,033	126%
Medicare (plans)	$18,026 - $20,146	128%
Eddy Seniorcare Pace	$18,033	128%
Secure Horizons Ma Pffs	$18,379	131%
UnitedHealthcare	$18,379 - $69,153	131%
Aetna	$19,086 - $41,446	136%
Medicaid / KanCare	$19,115	136%
Hudson Headwaters Pace	$19,701	140%
Nascentia Health Plus	$20,197	144%
Fidelis Care	$32,459	231%
Capital District Physicians Health Plan	$34,557	246%
1199 National Benefit Fund	$41,446	295%
Allied Benefit Systems	$41,446	295%
Asr Health Benefits	$41,446	295%
Christian Brother Services	$41,446	295%
Geha	$41,446	295%
Lucent Health	$41,446	295%
Luminare Health	$41,446	295%
Medical Mutual	$41,446	295%
Meritain	$41,446	295%
Trustmark Small Business Benefits	$41,446	295%
Emblem Health	$53,608	382%
Nova	$53,608	382%
Harvard Pilgrim Healthcare	$69,153	492%

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 $32,697.
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 St Peter's Hospital 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.