CMS Price Transparency Data

Hip or knee replacement (inpatient stay)

Facility: Queens Hospital Center

Billing Code: 470 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 470
Insurance Median: $42,141
Cash Discount Price: Unavailable
vs. Medicare Baseline: 3.00x Medicare

The contracted insurance negotiated median rate for a Hip or knee replacement (inpatient stay) at Queens Hospital Center is $42,141. 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 3.00x the Medicare baseline. Located in 82-68 164Th Street, Jamaica, NY.

Cash / Self-Pay

Unavailable

Average discount available for prompt cash payment at this facility.

Insurance Median

$42,141

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: $42,141 (300%)

Ins. Median: $42,141 (300% 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 300% of the Medicare baseline (a markup of 200%). 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	$30,722 - $42,141	219%
Cigna	$35,346	252%
Emblem	$36,056 - $42,141	257%
Aetna	$38,838 - $42,141	277%
United	$39,113 - $45,278	279%
Healthfirst	$39,191	279%
Centerlight	$41,298	294%
Blue Cross Blue Shield	$42,141	300%
Elderplan	$42,141	300%
Hamaspik	$42,141	300%
Senior Whole Health	$42,141 - $42,179	300%
Vaccn	$42,141	300%
Vnsny	$42,141	300%
Wellcare	$42,773	305%
Metroplus	$43,405	309%
Centers Plan For Healthy Living	$43,826	312%
Multiplan	$47,228	336%
Villagecare Max	$47,619	339%
Fidelis	$49,726 - $59,840	354%

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 Queens 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.