CMS Price Transparency Data

Hip or knee replacement (inpatient stay)

Facility: Duke University Hospital

Billing Code: 470 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 470
Insurance Median: $21,438
Cash Discount Price: $13,741
vs. Medicare Baseline: 1.53x Medicare

The contracted insurance negotiated median rate for a Hip or knee replacement (inpatient stay) at Duke University Hospital is $21,438. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $13,741. Compared to the federal Medicare reimbursement reference rate of $14,044.15, this hospital’s rate is 1.53x the Medicare baseline. Located in 2301 Erwin Rd, Durham, NC.

Cash / Self-Pay

$13,741

Average discount available for prompt cash payment at this facility.

Insurance Median

$21,438

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: $13,741 (98%)

Insurance Median: $21,438 (153%)

Cash: $13,741 (98% of Medicare)

Ins. Median: $21,438 (153% 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
Sentara	$7,939	57%
Humana	$10,832 - $17,227	77%
Troy Health	$12,743	91%
Voans	$12,743	91%
Cigna	$12,998 - $43,967	93%
Liberty	$12,998	93%
Aetna	$16,228 - $26,092	116%
Blue Cross Blue Shield	$16,800 - $28,001	120%
UnitedHealthcare	$16,800 - $35,662	120%
Alliance Health	$21,438	153%
Amerihealth	$21,438	153%
Carolina Complete Health	$21,438	153%
Partners	$21,438	153%
Trillium	$21,438	153%
Medcost	$21,647	154%

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 $13,741.
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 Duke University 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.