CMS Price Transparency Data

Hip or knee replacement (inpatient stay)

Facility: Blue Ridge Regional Hospital

Billing Code: 470 (MS-DRG)

Factual Cost Summary (Answer Capsule)
  • CPT Billing Code: 470
  • Insurance Median: $1,934
  • Cash Discount Price: Unavailable
  • vs. Medicare Baseline: 0.14x Medicare
The contracted insurance negotiated median rate for a Hip or knee replacement (inpatient stay) at Blue Ridge Regional Hospital is $1,934. 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 0.14x the Medicare baseline. Located in 125 Hospital Drive, Spruce Pine, NC.
Cash / Self-Pay
Unavailable

Average discount available for prompt cash payment at this facility.

Insurance Median
$1,934

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: $1,934 (14%)
Ins. Median: $1,934 (14% 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.

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
Blue Cross Blue Shield $1,723 - $20,744 12%
Aetna $1,860 13%
Apex Health $1,860 13%
United $1,860 13%
Alignment Health $1,897 14%
Devoted Health $1,897 14%
Cigna $1,916 14%
Humana $1,916 - $1,934 14%
Wellcare $1,916 - $21,366 14%
Nhc Advantage $1,934 14%
Provider Partners Health Plan $1,953 14%
Troy Healthcare $1,953 14%
Longevity Health Plan $1,990 14%
Amerihealth Caritas $2,120 15%
Vaya Health $21,366 152%
Amerihealth $21,574 154%
Partners Health Management $21,781 155%

Self-Pay Upfront Cash Action Plan

Insurance In-Network Protection Plan

Facility Profile & Credentials

  • Address: 125 Hospital Drive, Spruce Pine, NC 28777
  • CMS Rating: ★★★☆☆
  • Ownership Type: Voluntary non-profit - Private
  • Hospital Type: Critical Access Hospitals