CMS Price Transparency Data

Hip or knee replacement (inpatient stay)

Facility: Garnet Health Medical Center

Billing Code: 470 (MS-DRG)

The BaseRate · fair price high confidence

A fair price for this

$24,964

about 1.8× the $14,044 Medicare rate · typically $18,687–$41,276

modeled estimate · not a bill or quote

What this hospital charges insurers

$20,727

Below the fair price — a good deal

about $4,237 under the fair price · 1.5× Medicare

Medicare pays $14,044 Fair price $24,964 This hospital $20,727

How we calculate the fair BaseRate →

How this hospital compares to other NY hospitals

Highest price of the 9 NY hospitals we have prices for — worth calling around.

Cheapest $11,437 Priciest $20,727

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

A fair price for a Hip or knee replacement (inpatient stay) is about $24,964 (about 1.8× the $14,044 Medicare rate). Garnet Health Medical Center charges insurers about $20,727 — below the fair price — a good deal. Located in Middletown, 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	$20,727 - $59,935	148%
Blue Cross Blue Shieldmajor	$20,727	148%
Aetnamajor	$20,727 - $57,867	148%
Cignamajor	$20,727 - $58,270	148%
Humanamajor	$20,727	148%
CDPHP	$20,727 - $71,205	148%
Fidelis Care	$21,141	151%
Geisinger	$20,727 - $46,635	148%
MagnaCare	$74,629	531%
MVP Health Care	$20,727	148%
UPMC Health Plan	$20,727	148%
WellCare	$21,037	150%
+ 4 smaller / regional plans	$20,727 - $70,669

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, 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 Garnet Health Medical Center 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 Garnet Health Medical Center

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

Community Memorial Hospital, Inc · Hamilton $11,437
Kenmore Mercy Hospital · Kenmore $14,030
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

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