CMS Price Transparency Data

Hip or knee replacement (inpatient stay)

Facility: Carilion Medical Center

Billing Code: 470 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 470
Insurance Median: $65,096
Cash Discount Price: $36,747
vs. Medicare Baseline: 4.64x Medicare

The contracted insurance negotiated median rate for a Hip or knee replacement (inpatient stay) at Carilion Medical Center is $65,096. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $36,747. Compared to the federal Medicare reimbursement reference rate of $14,044.15, this hospital’s rate is 4.64x the Medicare baseline. Located in 1906 Belleview Avenue, Se, Roanoke, VA.

Cash / Self-Pay

$36,747

Average discount available for prompt cash payment at this facility.

Insurance Median

$65,096

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: $36,747 (262%)

Insurance Median: $65,096 (464%)

Cash: $36,747 (262% of Medicare)

Ins. Median: $65,096 (464% 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.

Elevated Commercial Rate Alert (Value-Gap)

The negotiated rate at this facility is 464% of the Medicare baseline (a markup of 364%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.

Consult Patient Advocate

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	$12,160 - $16,802	87%
Aetna	$15,484 - $69,715	110%
Blue Cross Blue Shield	$16,802 - $61,127	120%
UnitedHealthcare	$16,966 - $85,821	121%
Sentara Health Plan	$17,296 - $65,096	123%
Vhn - Ultra	$65,096	464%
Cigna	$70,765 - $75,595	504%
Gateway - Tier 3	$71,395	508%
Connecticare	$73,495	523%
Vhn - Plus	$80,844	576%
Gateway - Tier 2	$83,994	598%
Vhn	$83,994	598%
Vhn - Link	$94,494	673%
Gateway - Tier 1	$99,743	710%
Vhn - Secondary Payors	$99,743	710%

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 $36,747.
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 Carilion 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.