CMS Price Transparency Data

Hip or knee replacement (inpatient stay)

Facility: Uva Health Culpeper Medical Center

Billing Code: 470 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 470
Insurance Median: $21,209
Cash Discount Price: $33,824
vs. Medicare Baseline: 1.51x Medicare

The contracted insurance negotiated median rate for a Hip or knee replacement (inpatient stay) at Uva Health Culpeper Medical Center is $21,209. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $33,824. Compared to the federal Medicare reimbursement reference rate of $14,044.15, this hospital’s rate is 1.51x the Medicare baseline. Located in 501 Sunset Lane, Culpeper, VA.

Cash / Self-Pay

$33,824

Average discount available for prompt cash payment at this facility.

Insurance Median

$21,209

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: $33,824 (241%)

Insurance Median: $21,209 (151%)

Cash: $33,824 (241% of Medicare)

Ins. Median: $21,209 (151% 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
Tdo [99908]	$2,350 - $2,604	17%
Commonwealth Attorney [99931]	$2,372 - $2,604	17%
Blue Cross Blue Shield	$14,168 - $39,280	101%
Cigna	$14,168 - $49,812	101%
Medicare (plans)	$14,168 - $16,334	101%
UnitedHealthcare	$14,168 - $39,280	101%
VA Ccn [99926]	$14,168 - $22,090	101%
VA Ccn [99927]	$14,168 - $22,090	101%
Veterans Administration [99910]	$14,168 - $16,334	101%
Aetna	$14,310 - $43,591	102%
Humana	$14,341 - $16,248	102%
Blue Ridge Pace [10510]	$14,623	104%
Medicaid / KanCare	$14,623	104%
Veterans [99909]	$15,435	110%
HMO Part B [10099]	$16,248	116%
Geha [40009]	$20,328 - $29,979	145%
Carefirst [30007]	$26,059 - $28,947	186%
Sentara [40021]	$38,987 - $43,734	278%
Sentara Behavioral Health [40052]	$43,734	311%

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 $33,824.
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 Uva Health Culpeper 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.