Hip or knee replacement (inpatient stay)
Facility: Carolina East Medical Center
Billing Code: 470 (MS-DRG)
- CPT Billing Code: 470
- Insurance Median: $33,864
- Cash Discount Price: $27,879
- vs. Medicare Baseline: 2.41x Medicare
Average discount available for prompt cash payment at this facility.
Median negotiated contract rate across all mapped commercial carriers.
Standard federal government reimbursement rate for this code.
Visual Cost Comparison vs. 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.
Elevated Commercial Rate Alert (Value-Gap)
The negotiated rate at this facility is 241% of the Medicare baseline (a markup of 141%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.
Out-of-Pocket Cost Estimator
Estimate whether it is more economical to use your insurance or pay the upfront self-pay cash rate.
Commercial Insurance Negotiated Rates
Negotiated contract ranges established by major commercial carriers at this facility.
| Carrier / Plan Group | Contract Rate Range | vs. Medicare Reference |
|---|---|---|
| Pamlico Co Jail-All Plans | $12,360 | 88% |
| Tricare | $14,404 | 103% |
| Humana | $16,852 | 120% |
| Inclusive Health (Nchirp)-All Plans | $16,852 | 120% |
| Medcost Ppo Employees And Retirees | $26,429 | 188% |
| Medcost Ppo Ultra (Employees) | $26,429 | 188% |
| UnitedHealthcare | $33,037 | 235% |
| Blue Cross Blue Shield | $33,470 | 238% |
| Medcost Ppo City Employees | $33,864 | 241% |
| Medcost Ppo County Employee | $35,221 | 251% |
| Cigna | $37,710 | 269% |
| Benefit Mgmt, Svcs-All Plans | $39,496 | 281% |
| Medcost Benefit Svc-All Other Plans | $41,089 | 293% |
| Aetna | $41,168 | 293% |
| Acs Consult Svc Inc-All Plans | $41,995 | 299% |
| Medcost Ppo Standard | $41,995 | 299% |
| Craven Co. Jail Systems - All Plans | $53,890 | 384% |