CMS Price Transparency Data

Hip or knee replacement (inpatient stay)

Facility: Bertrand Chaffee Hospital

Billing Code: 470 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 470
Insurance Median: $17,317
Cash Discount Price: Unavailable
vs. Medicare Baseline: 1.23x Medicare

The contracted insurance negotiated median rate for a Hip or knee replacement (inpatient stay) at Bertrand Chaffee Hospital is $17,317. 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 1.23x the Medicare baseline. Located in 224 East Main Street, Springville, NY.

Cash / Self-Pay

Unavailable

Average discount available for prompt cash payment at this facility.

Insurance Median

$17,317

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: $17,317 (123%)

Ins. Median: $17,317 (123% 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
Comm Blue Essential	$1,856	13%
Community Blue	$1,856	13%
Community Care - Bc	$1,856	13%
Fidelis Care Of New York	$1,856 - $2,670	13%
Ghi Medical	$1,856	13%
Gowanda Correctional Fac	$1,856	13%
Medicaid / KanCare	$1,856	13%
Molina Essential Plan	$1,856	13%
Molina Heathcare Of Wny	$1,856	13%
Seneca Nation Health Dept	$1,856	13%
United Hc - Community Pln	$1,856	13%
United Hc Essential Plan	$1,856	13%
Univera Hc Myhealth	$1,856	13%
Univera Hc Myhealth+	$1,856	13%
Yourcare	$1,856	13%
Fidelis Essential Plans	$2,670	19%
Workers Compensation	$2,670	19%
Medicare (plans)	$16,971 - $17,317	121%
Advantra-Mcr Advantage	$17,317	123%
Aetna	$17,317	123%
Centers Plan Hlty Living	$17,317	123%
Champva	$17,317	123%
Cigna	$17,317	123%
Ctrs Plan For Hlthy Livng	$17,317	123%
Geisinger Health Plan	$17,317	123%
Humana	$17,317 - $17,988	123%
Lifetime Benefits	$17,317	123%
Mutual Of Omaha	$17,317	123%
Nova Healthcare	$17,317	123%
Optimum Healthcare - Mcr	$17,317	123%
Todays Option - Amer Prog	$17,317	123%
Tricare	$17,317	123%
United Hc Mcr Solutions	$17,317	123%
UnitedHealthcare	$17,317 - $17,988	123%
Univera Senior Choice	$17,317	123%
Wellcare	$17,317	123%
Iha Encompass 65	$17,837	127%
Blue Cross Blue Shield	$19,390 - $24,238	138%
Senior Blue - Bc	$19,816	141%

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 Bertrand Chaffee 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.