CMS Price Transparency Data

Hip or knee replacement (inpatient stay)

Facility: Healthalliance Hospital Marys Avenue Campus

Billing Code: 470 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 470
Insurance Median: $19,087
Cash Discount Price: $69,528
vs. Medicare Baseline: 1.36x Medicare

The contracted insurance negotiated median rate for a Hip or knee replacement (inpatient stay) at Healthalliance Hospital Marys Avenue Campus is $19,087. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $69,528. Compared to the federal Medicare reimbursement reference rate of $14,044.15, this hospital’s rate is 1.36x the Medicare baseline. Located in 105 Mary's Avenue, Kingston, NY.

Cash / Self-Pay

$69,528

Average discount available for prompt cash payment at this facility.

Insurance Median

$19,087

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: $69,528 (495%)

Insurance Median: $19,087 (136%)

Cash: $69,528 (495% of Medicare)

Ins. Median: $19,087 (136% 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
Magnacare	$7,456 - $18,178	53%
Va	$12,725	91%
Aetna	$18,178 - $53,561	129%
American Progress	$18,178	129%
Blue Cross Blue Shield	$18,178 - $64,648	129%
Blue Shield Of Ny	$18,178	129%
Cdphp	$18,178 - $48,582	129%
Emblem	$18,178 - $52,319	129%
Hamaspik	$18,178	129%
Health First	$18,178	129%
Mvp	$18,178 - $54,981	129%
Non Contracted	$18,178	129%
Todays Options	$18,178 - $19,996	129%
UnitedHealthcare	$18,178 - $54,086	129%
Wellcare	$18,178	129%
Oxford	$48,678 - $54,086	347%

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 $69,528.
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 Healthalliance Hospital Marys Avenue Campus 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.