CMS Price Transparency Data

Hip or knee replacement (inpatient stay)

Facility: Kenmore Mercy Hospital

Billing Code: 470 (MS-DRG)

The BaseRate · fair price high confidence

A fair price for this

$15,969

about 1.1× the $14,044 Medicare rate · typically $11,993–$20,434

modeled estimate · not a bill or quote

What this hospital charges insurers

$14,030

Below the fair price — a good deal

about $1,939 under the fair price · 1.0× Medicare

Medicare pays $14,044 Fair price $15,969 This hospital $14,030 Cash price $54,605 Hospital's list price $54,908

How we calculate the fair BaseRate →

How this hospital compares to other NY hospitals

One of the lower prices — 6 of 8 other NY hospitals charge more for the same procedure.

Cheapest $11,437 Priciest $17,317

Black dot = this hospital, among the 9 NY hospitals with a price for this procedure. Full list below.

⚠ The cash price looks unusually high next to the insurance price — it may be the full list price, not a real cash discount. Call to confirm the self-pay rate.

A fair price for a Hip or knee replacement (inpatient stay) is about $15,969 (about 1.1× the $14,044 Medicare rate). Kenmore Mercy Hospital charges insurers about $14,030, or about $54,605 in cash — below the fair price — a good deal. Located in Kenmore, NY.

What each insurance company pays

Which insurers have negotiated a price with this hospital for this procedure — and which haven’t.

5 of 6 major insurers have a published price at this hospital

✓ UnitedHealthcare✓ Blue Cross Blue Shield✓ Aetna✓ Cigna✓ Humana Kaiser Permanente

Crossed out = this hospital hasn’t published a negotiated price for that insurer for this procedure. It doesn’t necessarily mean they aren’t accepted — ask your insurer.

Insurance company	Price range	vs. Medicare
UnitedHealthcaremajor	$12,292 - $34,798	88%
Blue Cross Blue Shieldmajor	$12,292 - $40,137	88%
Aetnamajor	$14,030	100%
Cignamajor	$14,030	100%
Humanamajor	$14,030	100%
Amerigroup	$12,292	88%
Fidelis Care	$12,292 - $18,709	88%
Independent Health	$12,292 - $37,578	88%
Molina	$12,292	88%
MVP Health Care	$19,126	136%
UPMC Health Plan	$32,804	234%
WellCare	$14,030	100%
+ 14 smaller / regional plans	$11,329 - $36,053

Government programs also on file: Medicare, Medicaid, Military & VA.

Excludes 1 rental-network / third-party entry (e.g. Multiplan, PHCS) — these are pricing networks, not insurers.

Self-Pay How to get the cash price

Tell the billing desk you want to be billed as self-pay — not through insurance — before your visit.
Ask for the cash / prompt-pay discount in writing, with the exact price (about 54,605), before you agree to anything.
Get it in writing that they won’t also bill your insurance, so the cash price is what you owe.
Check the MS-DRG code on your bill matches exactly: 470.

Insurance Before you use insurance

Call your insurance company to confirm Kenmore Mercy Hospital is in-network.
Ask your insurer whether prior approval is required for MS-DRG code 470.
Confirm the doctor or provider is in-network too — not just the hospital building.
Check your Explanation of Benefits against the hospital’s final itemized bill.

Estimate your out-of-pocket cost

A rough estimate of what you’d pay with insurance (deductible + coinsurance) versus paying the cash price yourself.

How you’d pay

Deductible left to meet ($)

Your coinsurance (%)

Enter your details and press estimate to compare.

Other Procedures at Kenmore Mercy Hospital

Compare: Hip or knee replacement (inpatient stay) at other NY hospitals

Community Memorial Hospital, Inc · Hamilton $11,437
Mercy Hospital of Buffalo · Buffalo $14,030
Montefiore St Luke's Cornwall · Newburgh $16,352
Montefiore Mount Vernon Hospital · Mount Vernon $16,502
Montefiore New Rochelle Hospital · New Rochelle $16,578
Glens Falls Hospital · Glens Falls $17,096
Geneva General Hospital · Geneva $17,152
Bertrand Chaffee Hospital · Springville $17,317

Insurance negotiated median for the same procedure, sorted lowest first.