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New York rates for MS-DRG 469

Major joint replacement or reattachment of lower extremity w MCC

Facilitymedian $74,131 · 10th–90th $29,512$117,4900%10%10th90th$74,131$2.0K$5.0K$10.0K$20.0K$50.0K$100.0K$200.0K

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$24,547.09 / $63,095.73 / $117,489.76
Anthem BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$63,095.73 / $83,176.38 / $109,647.82
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$53,703.18 / $85,113.80 / $117,489.76
Emblem Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$41,686.94 / $77,624.71 / $190,546.07
Highmark BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$30,199.52 / $30,199.52 / $30,199.52
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$19,054.61 / $64,565.42 / $109,647.82