CMS Price Transparency Data

Hip or knee replacement (inpatient stay)

Facility: Metropolitan Hospital Center

Billing Code: 470 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 470
Insurance Median: $59,371
Cash Discount Price: Unavailable
vs. Medicare Baseline: 4.23x Medicare

The contracted insurance negotiated median rate for a Hip or knee replacement (inpatient stay) at Metropolitan Hospital Center is $59,371. 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 4.23x the Medicare baseline. Located in 1901 First Avenue, New York, NY.

Cash / Self-Pay

Unavailable

Average discount available for prompt cash payment at this facility.

Insurance Median

$59,371

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: $59,371 (423%)

Ins. Median: $59,371 (423% 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 423% of the Medicare baseline (a markup of 323%). 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	$32,121 - $59,371	229%
Aetna	$33,468 - $59,371	238%
Cigna	$35,346	252%
Emblem	$36,056 - $59,371	257%
United	$40,891 - $47,339	291%
Multiplan	$41,664	297%
Healthfirst	$55,215	393%
Senior Whole Health	$56,102 - $59,371	399%
Centerlight	$58,184	414%
Blue Cross Blue Shield	$59,371	423%
Elderplan	$59,371	423%
Fidelis	$59,371 - $84,307	423%
Hamaspik	$59,371	423%
Vaccn	$59,371	423%
Villagecare Max	$59,371	423%
Vnsny	$59,371	423%
Wellcare	$60,262	429%
Metroplus	$61,152	435%
Centers Plan For Healthy Living	$61,746	440%

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 Metropolitan 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.