CMS Price Transparency Data

Hip or knee replacement (inpatient stay)

Facility: Hospital for Special Surgery

Billing Code: 470 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 470
Insurance Median: $68,940
Cash Discount Price: $79,244
vs. Medicare Baseline: 4.91x Medicare

The contracted insurance negotiated median rate for a Hip or knee replacement (inpatient stay) at Hospital for Special Surgery is $68,940. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $79,244. Compared to the federal Medicare reimbursement reference rate of $14,044.15, this hospital’s rate is 4.91x the Medicare baseline. Located in 535 East 70Th Street, New York, NY.

Cash / Self-Pay

$79,244

Average discount available for prompt cash payment at this facility.

Insurance Median

$68,940

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: $79,244 (564%)

Insurance Median: $68,940 (491%)

Cash: $79,244 (564% of Medicare)

Ins. Median: $68,940 (491% 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 491% of the Medicare baseline (a markup of 391%). 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
Connecticare [1039]	$17,974 - $74,336	128%
Medicare (plans)	$17,974	128%
UnitedHealthcare	$17,974 - $76,712	128%
Oxford [1096]	$61,508	438%
Apwu [1016]	$61,800	440%
Cigna	$61,800	440%
Nalc [1090]	$61,800	440%
Qualcare [1101]	$61,800	440%
Wellfleet [1361]	$61,800	440%
Blue Cross Blue Shield	$62,900 - $74,336	448%
Emblem Health [1043]	$62,900 - $74,336	448%
Geha [1053]	$68,940	491%
Student Resources [1103]	$68,940	491%
Aetna	$69,635	496%
Christian Brothers [1034]	$69,635	496%
Meritain Health [1085]	$69,635	496%
Nippon Life [1092]	$69,635	496%
Webtpa [1356]	$69,635	496%
Harvard Pilgrim [1057]	$76,712	546%

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 $79,244.
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 Hospital for Special Surgery 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.