CMS Price Transparency Data

Hip or knee replacement (inpatient stay)

Facility: St Charles Hospital

Billing Code: 470 (MS-DRG)

The BaseRate · fair price high confidence

A fair price for this

$25,089

about 1.8× the $14,044 Medicare rate · typically $17,715–$39,272

modeled estimate · not a bill or quote

What this hospital charges insurers

$22,861

About the fair price

about $2,228 under the fair price · 1.6× Medicare

Medicare pays $14,044 Fair price $25,089 This hospital $22,861

How we calculate the fair BaseRate →

How this hospital compares to other NY hospitals

Highest price of the 9 NY hospitals we have prices for — worth calling around.

Cheapest $11,437 Priciest $22,861

Black dot = this hospital, among the 9 NY hospitals with a price for this procedure. Full list below.

A fair price for a Hip or knee replacement (inpatient stay) is about $25,089 (about 1.8× the $14,044 Medicare rate). St Charles Hospital charges insurers about $22,861 — about the fair price. Located in Port Jefferson, NY.

What each insurance company pays

Which insurers have negotiated a price with this hospital for this procedure — and which haven’t.

5 of 6 major insurers have a published price at this hospital

✓ UnitedHealthcare✓ Blue Cross Blue Shield✓ Aetna✓ Cigna✓ Humana Kaiser Permanente

Crossed out = this hospital hasn’t published a negotiated price for that insurer for this procedure. It doesn’t necessarily mean they aren’t accepted — ask your insurer.

Insurance company	Price range	vs. Medicare
UnitedHealthcaremajor	$17,585 - $43,764	125%
Blue Cross Blue Shieldmajor	$17,234 - $43,764	123%
Aetnamajor	$17,733 - $39,267	126%
Cignamajor	$33,996	242%
Humanamajor	$17,937	128%
AmeriHealth	$43,136	307%
Cigna HealthSpring	$17,585	125%
Fidelis Care	$17,585	125%
Independent Health	$17,585	125%
MVP Health Care	$17,585 - $33,996	125%
WellCare	$18,289	130%
+ 32 smaller / regional plans	$6,454 - $43,696

Government programs also on file: Medicare, Military & VA.

Excludes 1 rental-network / third-party entry (e.g. Multiplan, PHCS) — these are pricing networks, not insurers.

Self-Pay How to get the cash price

Tell the billing desk you want to be billed as self-pay — not through insurance — before your visit.
Ask for the cash / prompt-pay discount in writing, with the exact price, before you agree to anything.
Get it in writing that they won’t also bill your insurance, so the cash price is what you owe.
Check the MS-DRG code on your bill matches exactly: 470.

Insurance Before you use insurance

Call your insurance company to confirm St Charles Hospital is in-network.
Ask your insurer whether prior approval is required for MS-DRG code 470.
Confirm the doctor or provider is in-network too — not just the hospital building.
Check your Explanation of Benefits against the hospital’s final itemized bill.

Estimate your out-of-pocket cost

A rough estimate of what you’d pay with insurance (deductible + coinsurance) versus paying the cash price yourself.

How you’d pay

Deductible left to meet ($)

Your coinsurance (%)

Enter your details and press estimate to compare.

Other Procedures at St Charles Hospital

Compare: Hip or knee replacement (inpatient stay) at other NY hospitals

Community Memorial Hospital, Inc · Hamilton $11,437
Kenmore Mercy Hospital · Kenmore $14,030
Mercy Hospital of Buffalo · Buffalo $14,030
Montefiore St Luke's Cornwall · Newburgh $16,352
Montefiore Mount Vernon Hospital · Mount Vernon $16,502
Montefiore New Rochelle Hospital · New Rochelle $16,578
Glens Falls Hospital · Glens Falls $17,096
Geneva General Hospital · Geneva $17,152

Insurance negotiated median for the same procedure, sorted lowest first.