CMS Price Transparency Data

Hip or knee replacement (inpatient stay)

Facility: Pender Memorial Hospital

Billing Code: 470 (MS-DRG)

The BaseRate · fair price high confidence

A fair price for this

$22,965

about 1.6× the $14,044 Medicare rate · typically $10,383–$27,295

modeled estimate · not a bill or quote

What this hospital charges insurers

$19,826

Below the fair price — a good deal

about $3,139 under the fair price · 1.4× Medicare

Medicare pays $14,044 Fair price $22,965 This hospital $19,826

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 $19,826

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 $22,965 (about 1.6× the $14,044 Medicare rate). Pender Memorial Hospital charges insurers about $19,826 — below the fair price — a good deal. Located in Burgaw, NC.

What each insurance company pays

Which insurers have negotiated a price with this hospital for this procedure — and which haven’t.

4 of 6 major insurers have a published price at this hospital

✓ Blue Cross Blue Shield✓ Aetna✓ Cigna✓ Humana UnitedHealthcareKaiser 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
Blue Cross Blue Shieldmajor	$2,453 - $3,107	17%
Aetnamajor	$1,850 - $3,185	13%
Cignamajor	$3,200 - $21,642	23%
Humanamajor	$1,709 - $3,107	12%
Ambetter (Centene)	$4,661	33%
AmeriHealth	$19,826	141%
CareSource	$21,218	151%
WellCare	$19,826	141%
+ 5 smaller / regional plans	$3,107 - $19,437

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, 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 Pender Memorial 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 Pender Memorial 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.