CMS Price Transparency Data

Hip or knee replacement (inpatient stay)

Facility: North Carolina Baptist Hospital

Billing Code: 470 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 470
Insurance Median: $23,240
Cash Discount Price: Unavailable
vs. Medicare Baseline: 1.65x Medicare

The contracted insurance negotiated median rate for a Hip or knee replacement (inpatient stay) at North Carolina Baptist Hospital is $23,240. 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 1.65x the Medicare baseline. Located in Medical Center Boulevard, Winston-Salem, NC.

Cash / Self-Pay

Unavailable

Average discount available for prompt cash payment at this facility.

Insurance Median

$23,240

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: $23,240 (165%)

Ins. Median: $23,240 (165% 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
Amerihealth	$18,453 - $19,023	131%
Carolina Complete	$18,453	131%
Health Blue	$18,453	131%
Partners	$18,453	131%
Vaya	$18,638	133%
UnitedHealthcare	$18,639 - $28,616	133%
Wellcare	$18,639 - $23,240	133%
Alliance	$18,822	134%
Blue Cross Blue Shield	$18,959 - $30,443	135%
Trillium	$19,007	135%
Ambetter / Centene	$19,702	140%
Aetna	$23,240	165%
Apex	$23,240	165%
Cigna	$23,240 - $30,414	165%
Devoted	$23,240	165%
Healthteam	$23,240	165%
Humana	$23,472	167%
Medicare (plans)	$23,472	167%
Liberty	$26,726	190%

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 North Carolina Baptist 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.