CMS Price Transparency Data

Hip or knee replacement (inpatient stay)

Facility: Jacobi Medical Center

Billing Code: 470 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 470
Insurance Median: $30,378
Cash Discount Price: Unavailable
vs. Medicare Baseline: 2.16x Medicare

The contracted insurance negotiated median rate for a Hip or knee replacement (inpatient stay) at Jacobi Medical Center is $30,378. 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 2.16x the Medicare baseline. Located in 1400 Pelham Parkway South, Bronx, NY.

Cash / Self-Pay

Unavailable

Average discount available for prompt cash payment at this facility.

Insurance Median

$30,378

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: $30,378 (216%)

Ins. Median: $30,378 (216% 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.

Elevated Commercial Rate Alert (Value-Gap)

The negotiated rate at this facility is 216% of the Medicare baseline (a markup of 116%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.

Consult Patient Advocate

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
Oscar	$17,861	127%
Local 1199	$23,671	169%
Healthfirst	$28,252	201%
Centerlight	$29,770	212%
Aetna	$30,378 - $42,013	216%
Blue Cross Blue Shield	$30,378	216%
Elderplan	$30,378	216%
Emblem	$30,378 - $36,056	216%
Fidelis	$30,378 - $43,137	216%
Hamaspik	$30,378	216%
Oxford	$30,378 - $49,977	216%
Senior Whole Health	$30,378 - $30,859	216%
Vaccn	$30,378	216%
Vnsny	$30,378	216%
Wellcare	$30,834	220%
Metroplus	$31,289	223%
Centers Plan For Healthy Living	$31,593	225%
Villagecare Max	$34,327	244%
Cigna	$35,346	252%
Multiplan	$48,957	349%
United	$53,333 - $61,739	380%

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 Jacobi 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.