CMS Price Transparency Data

Hip or knee replacement (inpatient stay)

Facility: Carilion Medical Center

Billing Code: 470 (MS-DRG)

The BaseRate · fair price high confidence

A fair price for this

$18,222

about 1.3× the $14,044 Medicare rate · typically $15,943–$23,462

modeled estimate · not a bill or quote

What this hospital charges insurers

$16,884

About the fair price

about $1,338 under the fair price · 1.2× Medicare

Medicare pays $14,044 Fair price $18,222 This hospital $16,884 Cash price $36,747 Hospital's list price $104,993

How we calculate the fair BaseRate →

How this hospital compares to other VA hospitals

Highest price of the 9 VA hospitals we have prices for — worth calling around.

Cheapest $8,878 Priciest $16,884

Black dot = this hospital, among the 9 VA hospitals with a price for this procedure. Full list below.

A fair price for a Hip or knee replacement (inpatient stay) is about $18,222 (about 1.3× the $14,044 Medicare rate). Carilion Medical Center charges insurers about $16,884, or about $36,747 in cash — about the fair price. Located in Roanoke, VA.

What each insurance company pays

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

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

✓ UnitedHealthcare✓ Blue Cross Blue Shield✓ Aetna✓ Cigna✓ Humana Kaiser 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
UnitedHealthcaremajor	$16,966 - $85,821	121%
Blue Cross Blue Shieldmajor	$16,802 - $61,127	120%
Aetnamajor	$15,484 - $69,715	110%
Cignamajor	$70,765 - $75,595	504%
Humanamajor	$12,160 - $16,802	87%
Sentara	$17,296 - $65,096	123%
+ 8 smaller / regional plans	$65,096 - $99,743

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 (about 36,747), 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 Carilion Medical Center 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 Carilion Medical Center

Compare: Hip or knee replacement (inpatient stay) at other VA hospitals

Carilion Stonewall Jackson Hospital · Lexington $8,878
Childrens Hospital of the Kings Daughters Inc · Norfolk $11,164
Sentara Rmh Medical Center · Harrisonburg $14,457
Sovah Health Danville · Danville $14,523
Clinch Valley Medical Center · Richlands $14,645
Lewisgale Hospital Alleghany · Low Moor $14,889
Sentara Halifax Regional Hospital · South Boston $14,993
Lewisgale Hospital Pulaski · Pulaski $15,116

Insurance negotiated median for the same procedure, sorted lowest first.