CMS Price Transparency Data

Hip or knee replacement (inpatient stay)

Facility: Duke University Hospital

Billing Code: 470 (MS-DRG)

The BaseRate · fair price high confidence

A fair price for this

$20,276

about 1.4× the $14,044 Medicare rate · typically $12,533–$21,202

modeled estimate · not a bill or quote

What this hospital charges insurers

$21,438

About the fair price

about $1,162 over the fair price · 1.5× Medicare

Medicare pays $14,044 Fair price $20,276 This hospital $21,438 Cash price $13,741 Hospital's list price $50,892

How we calculate the fair BaseRate →

How this hospital compares to other NC hospitals

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

Cheapest $12,504 Priciest $21,438

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

A fair price for a Hip or knee replacement (inpatient stay) is about $20,276 (about 1.4× the $14,044 Medicare rate). Duke University Hospital charges insurers about $21,438, or about $13,741 in cash — about the fair price. Located in Durham, NC.

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	$16,800 - $35,662	120%
Blue Cross Blue Shieldmajor	$16,800 - $28,001	120%
Aetnamajor	$16,228 - $26,092	116%
Cignamajor	$12,998 - $43,967	93%
Humanamajor	$10,832 - $17,227	77%
AmeriHealth	$21,438	153%
Sentara	$7,939	57%
+ 7 smaller / regional plans	$12,743 - $21,438

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 (about 13,741), 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 Duke University 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 Duke University Hospital

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

Maria Parham Medical Center · Henderson $12,504
Haywood Regional Medical Center · Clyde $12,776
Frye Regional Medical Center · Hickory $13,055
Sentara Albemarle Medical Center · Elizabeth City $13,600
Wilson Medical Center · Wilson $13,765
Rutherford Regional Medical Center · Rutherfordton $14,262
Harris Regional Hospital · Sylva $14,371
Carteret General Hospital · Morehead City $15,195

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