CMS Price Transparency Data

Hip or knee replacement (inpatient stay)

Facility: Margaretville Memorial Hospital

Billing Code: 470 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 470
Insurance Median: $3,735
Cash Discount Price: Unavailable
vs. Medicare Baseline: 0.27x Medicare

The contracted insurance negotiated median rate for a Hip or knee replacement (inpatient stay) at Margaretville Memorial Hospital is $3,735. 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 0.27x the Medicare baseline. Located in 42084 State Highway 28, Margaretville, NY.

Cash / Self-Pay

Unavailable

Average discount available for prompt cash payment at this facility.

Insurance Median

$3,735

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: $3,735 (27%)

Ins. Median: $3,735 (27% 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
Medicare (plans)	$2,654 - $3,633	19%
Todays Options	$2,920	21%
Hamaspik (McR)	$3,395	24%
UnitedHealthcare	$3,395 - $55,330	24%
Mvp Gold (McR)	$3,395	24%
Aetna	$3,395 - $54,794	24%
Blue Cross Blue Shield	$3,395 - $68,480	24%
Affinity By Molina McR	$3,565	25%
Cdphp	$3,735	27%
Magnacare Preferred	$7,456	53%
Emblem Select Care (Exchange)	$47,542	339%
Mvp Exchange	$47,810	340%
Emblem Ghi/Hip Ppo/Cbp	$53,523	381%
Emblem Ghi/Hip Hmo/Epo/Pos	$55,932	398%
Mvp Hmo/Ppo	$56,247	401%
Self-Pay	$71,222	507%

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 Margaretville Memorial Hospital 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.