CMS Price Transparency Data

Hip or knee replacement (inpatient stay)

Facility: Maimonides Medical Center

Billing Code: 470 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 470
Insurance Median: $30,804
Cash Discount Price: Unavailable
vs. Medicare Baseline: 2.19x Medicare

The contracted insurance negotiated median rate for a Hip or knee replacement (inpatient stay) at Maimonides Medical Center is $30,804. 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 2.19x the Medicare baseline. Located in 4802 Tenth Avenue, Brooklyn, NY.

Cash / Self-Pay

Unavailable

Average discount available for prompt cash payment at this facility.

Insurance Median

$30,804

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: $30,804 (219%)

Ins. Median: $30,804 (219% 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 219% of the Medicare baseline (a markup of 119%). 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
Healthfirst	$23,873	170%
Centerlight Healthcare	$24,387	174%
Centerlight Healthcare Fida	$24,387	174%
Molina	$24,387	174%
Aetna	$25,670 - $46,413	183%
Blue Cross Blue Shield	$25,670 - $60,517	183%
Centers Plan For Healthy Living	$25,670	183%
Cigna	$25,670 - $55,556	183%
Elderplan	$25,670	183%
Elderplan Fida	$25,670	183%
Emblem Health - Ghi	$25,670 - $56,513	183%
Emblem Health - Hip	$25,670 - $54,241	183%
Emblem Health - Hip Vip	$25,670	183%
Emblem Health - Hip Vip Fida	$25,670	183%
Fidelis	$25,670	183%
Healthfirst Fida	$25,670	183%
UnitedHealthcare	$25,670 - $61,611	183%
Villagecare Maxx Fida	$25,670	183%
Visiting Nurse Svc Of Ny	$25,670	183%
Wellcare	$25,670	183%
United Community Plan	$28,237	201%
Metroplus	$30,804	219%
Metroplus Fida	$30,804	219%
Local 1199	$31,725	226%
Oxford Health Plan	$50,763	361%
Oxford Liberty	$50,763	361%
Centivo	$59,294	422%
Magnacare	$66,451	473%

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 Maimonides 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.