CMS Price Transparency Data

Vaginal delivery (full package)

Facility: St James Hospital

Billing Code: 59400 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 59400
Insurance Median: $2,025
Cash Discount Price: Unavailable
vs. Medicare Baseline: 0.91x Medicare

The contracted insurance negotiated median rate for a Vaginal delivery (full package) at St James Hospital is $2,025. 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 $2,214.42, this hospital’s rate is 0.91x the Medicare baseline. Located in 411 Canisteo Street, Hornell, NY.

Cash / Self-Pay

Unavailable

Average discount available for prompt cash payment at this facility.

Insurance Median

$2,025

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$2,214.42

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $2,214.42 (100%)

Insurance Median: $2,025 (91%)

Ins. Median: $2,025 (91% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $2,214.42 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
Blue Cross Blue Shield	$1,421 - $3,070	64%
Medicaid / KanCare	$1,477 - $2,239	67%
Aetna	$1,715 - $2,295	77%
Fidelis 5155	$1,744 - $2,048	79%
Mvp 2900	$1,817 - $2,138	82%
Medicare (plans)	$1,819 - $2,341	82%
UnitedHealthcare	$1,891 - $2,295	85%
Excellus 2201	$1,951 - $2,295	88%
Cigna	$2,508 - $2,950	113%
Capital District Physicians Health Plan (Cdphp) 5149	$5,817	263%

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 CPT Code matches exactly: 59400.

Insurance In-Network Protection Plan

Contact your insurance company to confirm St James Hospital is fully in-network.
Ask your insurer if "Prior Authorization" is required for CPT code 59400.
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.