CMS Price Transparency Data

Hip or knee replacement (inpatient stay)

Facility: Olean General Hospital

Billing Code: 470 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 470
Insurance Median: $18,522
Cash Discount Price: Unavailable
vs. Medicare Baseline: 1.32x Medicare

The contracted insurance negotiated median rate for a Hip or knee replacement (inpatient stay) at Olean General Hospital is $18,522. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is unavailable. Compared to the federal Medicare reimbursement reference rate of $14,044.15, this hospital’s rate is 1.32x the Medicare baseline. Located in 515 Main Street, Olean, NY.

Cash / Self-Pay

Unavailable

Average discount available for prompt cash payment at this facility.

Insurance Median

$18,522

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%)

Insurance Median: $18,522 (132%)

Ins. Median: $18,522 (132% 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
Emblem Health	$7,304	52%
Aetna	$8,547 - $19,634	61%
Highmark - Bradford	$12,002	85%
Independent Health Association	$13,202 - $13,653	94%
Cigna	$13,338	95%
UnitedHealthcare	$16,988 - $23,026	121%
Blue Cross Blue Shield	$17,967 - $26,468	128%
Univera	$18,152	129%
Upmc	$18,459 - $18,893	131%
Healthpartners	$18,522	132%
Humana	$18,522	132%
Mvp	$18,522	132%
Nalc	$18,522	132%
Pa Health And Wellness	$18,522	132%
Seneca Nation-Lion John Hc	$18,522	132%
Total Senior Care	$18,522	132%
Fidelis	$19,448	138%
Geisinger	$19,448	138%
Wellcare	$19,448	138%
Fidelis Care	$24,079	171%

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 $X.
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 Olean General 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.