CMS Price Transparency Data

Hip or knee replacement (inpatient stay)

Facility: Arnot Ogden Medical Center

Billing Code: 470 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 470
Insurance Median: $20,814
Cash Discount Price: $35,994
vs. Medicare Baseline: 1.48x Medicare

The contracted insurance negotiated median rate for a Hip or knee replacement (inpatient stay) at Arnot Ogden Medical Center is $20,814. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $35,994. Compared to the federal Medicare reimbursement reference rate of $14,044.15, this hospital’s rate is 1.48x the Medicare baseline. Located in 600 Roe Avenue, Elmira, NY.

Cash / Self-Pay

$35,994

Average discount available for prompt cash payment at this facility.

Insurance Median

$20,814

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: $35,994 (256%)

Insurance Median: $20,814 (148%)

Cash: $35,994 (256% of Medicare)

Ins. Median: $20,814 (148% 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
UnitedHealthcare	$6,929 - $20,149	49%
Tricare	$12,281	87%
Martins Point Mcr Adv - All Plans	$14,501	103%
Emblem/Ghi	$14,642	104%
Blue Cross Blue Shield	$15,666 - $25,155	112%
Humana	$16,453 - $32,394	117%
Amerihealth Mcr Adv - All Plans	$16,618	118%
Healthnow - All Plans	$16,695	119%
Aetna	$16,766 - $23,237	119%
Emblem Health - All Plans	$16,915	120%
Upmc Health Plan - All Plans	$21,479	153%
Fidelis Care-Exchange - All Plans	$22,949	163%
Pomco Inc - All Plans	$23,654	168%
Independent Health - All Plans	$23,940	170%
Geisinger	$24,128 - $52,277	172%
Fidelis	$25,561	182%
Geisinger - All Plans	$25,953	185%
Cigna	$26,052	186%
Mvp Health Plan - All Plans	$26,052	186%

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 $35,994.
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 Arnot Ogden Medical Center 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.