CMS Price Transparency Data

Hip or knee replacement (inpatient stay)

Facility: Catawba Valley Medical Center

Billing Code: 470 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 470
Insurance Median: $13,929
Cash Discount Price: $20,251
vs. Medicare Baseline: 0.99x Medicare

The contracted insurance negotiated median rate for a Hip or knee replacement (inpatient stay) at Catawba Valley Medical Center is $13,929. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $20,251. Compared to the federal Medicare reimbursement reference rate of $14,044.15, this hospital’s rate is 0.99x the Medicare baseline. Located in 810 Fairgrove Church Rd, Hickory, NC.

Cash / Self-Pay

$20,251

Average discount available for prompt cash payment at this facility.

Insurance Median

$13,929

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: $20,251 (144%)

Insurance Median: $13,929 (99%)

Cash: $20,251 (144% of Medicare)

Ins. Median: $13,929 (99% 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
Humana	$2,856 - $28,688	20%
Cigna	$2,884 - $33,751	21%
Wellcare	$2,884	21%
Blue Cross Blue Shield	$2,940 - $16,369	21%
Devoted Health	$2,940	21%
Gateway	$2,940	21%
Longevity Healthcare	$2,940	21%
Liberty Advantage	$2,968	21%
Troy	$2,968	21%
Caresource North Carolina	$5,320	38%
UnitedHealthcare	$13,682 - $16,876	97%
Medcost	$14,175 - $23,288	101%
Prime Health Service	$25,313	180%
Aetna	$26,924	192%
Directnet	$27,000	192%
Multiplan	$28,688	204%

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 $20,251.
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 Catawba Valley Medical Center 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.