CMS Price Transparency Data

Hip or knee replacement (inpatient stay)

Facility: Elmhurst Hospital Center

Billing Code: 470 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 470
Insurance Median: $40,494
Cash Discount Price: Unavailable
vs. Medicare Baseline: 2.88x Medicare

The contracted insurance negotiated median rate for a Hip or knee replacement (inpatient stay) at Elmhurst Hospital Center is $40,494. 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 2.88x the Medicare baseline. Located in 79-01 Broadway, Elmhurst, NY.

Cash / Self-Pay

Unavailable

Average discount available for prompt cash payment at this facility.

Insurance Median

$40,494

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: $40,494 (288%)

Ins. Median: $40,494 (288% 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 288% of the Medicare baseline (a markup of 188%). 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%
Oxford	$26,531 - $40,494	189%
Aetna	$33,468 - $40,494	238%
United	$33,779 - $51,457	241%
Cigna	$35,346	252%
Emblem	$36,056 - $40,494	257%
Healthfirst	$37,660	268%
Centerlight	$39,684	283%
Blue Cross Blue Shield	$40,494	288%
Elderplan	$40,494	288%
Fidelis	$40,494 - $57,502	288%
Hamaspik	$40,494	288%
Senior Whole Health	$40,494 - $41,160	288%
Vaccn	$40,494	288%
Villagecare Max	$40,494	288%
Vnsny	$40,494	288%
Wellcare	$41,102	293%
Metroplus	$41,709	297%
Centers Plan For Healthy Living	$42,114	300%
Multiplan	$48,504	345%

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 Elmhurst Hospital 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.