CMS Price Transparency Data

Hip or knee replacement (inpatient stay)

Facility: St Anthony Community Hospital

Billing Code: 470 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 470
Insurance Median: $25,427
Cash Discount Price: $25,619
vs. Medicare Baseline: 1.81x Medicare

The contracted insurance negotiated median rate for a Hip or knee replacement (inpatient stay) at St Anthony Community Hospital is $25,427. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $25,619. Compared to the federal Medicare reimbursement reference rate of $14,044.15, this hospital’s rate is 1.81x the Medicare baseline. Located in 15 Maple Avenue -19, Warwick, NY.

Cash / Self-Pay

$25,619

Average discount available for prompt cash payment at this facility.

Insurance Median

$25,427

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%)

Cash / Self-Pay: $25,619 (182%)

Insurance Median: $25,427 (181%)

Cash: $25,619 (182% of Medicare)

Ins. Median: $25,427 (181% 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.

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
First Health	$1,664	12%
Multiplan	$5,836	42%
Aetna	$17,080 - $54,506	122%
Blue Cross Blue Shield	$17,080	122%
Cdphp	$17,080	122%
Emblem	$17,080 - $62,570	122%
Fidelis	$17,080	122%
Geisinger	$17,080 - $38,771	122%
Hamaspik	$17,080	122%
Magnacare	$17,080 - $71,734	122%
Mvp	$17,080 - $61,279	122%
Non Contracted	$17,080	122%
Oxford	$17,080 - $50,777	122%
Partners Health Plan	$17,080	122%
UnitedHealthcare	$17,080 - $50,777	122%
Wellcare	$17,080	122%
Health First	$18,275	130%
Tricare	$23,931	170%
World Trade Center	$25,427	181%
Cigna	$58,426	416%

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 $25,619.
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 St Anthony Community Hospital 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.