CMS Price Transparency Data

Hip or knee replacement (inpatient stay)

Facility: Westchester Medical Center

Billing Code: 470 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 470
Insurance Median: $45,456
Cash Discount Price: $106,035
vs. Medicare Baseline: 3.24x Medicare

The contracted insurance negotiated median rate for a Hip or knee replacement (inpatient stay) at Westchester Medical Center is $45,456. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $106,035. Compared to the federal Medicare reimbursement reference rate of $14,044.15, this hospital’s rate is 3.24x the Medicare baseline. Located in 100 Woods Rd, Valhalla, NY.

Cash / Self-Pay

$106,035

Average discount available for prompt cash payment at this facility.

Insurance Median

$45,456

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: $106,035 (755%)

Insurance Median: $45,456 (324%)

Cash: $106,035 (755% of Medicare)

Ins. Median: $45,456 (324% 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 324% of the Medicare baseline (a markup of 224%). 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
Value Options	$1,523 - $1,539	11%
Emblem	$12,065 - $98,708	86%
Va	$15,143	108%
Cdphp	$21,298 - $99,398	152%
Aetna	$21,632 - $88,955	154%
Blue Cross Blue Shield	$21,632 - $101,954	154%
Cigna	$21,632 - $97,184	154%
Health First	$21,632	154%
Magnacare	$21,632 - $123,357	154%
Mvp	$21,632 - $83,714	154%
Non Contracted	$21,632	154%
Oxford	$21,632 - $78,763	154%
Partners Health Plan	$21,632	154%
Todays Options	$21,632	154%
UnitedHealthcare	$21,632 - $78,763	154%
Wellcare	$21,632 - $40,020	154%
Oscar	$22,281	159%
Vns Choice	$22,281	159%
Molina	$22,714	162%
Tricare	$29,303	209%

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 $106,035.
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 Westchester 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.