CMS Price Transparency Data

Hip or knee replacement (inpatient stay)

Facility: Carilion New River Valley Medical Center

Billing Code: 470 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 470
Insurance Median: $72,722
Cash Discount Price: $41,053
vs. Medicare Baseline: 5.18x Medicare

The contracted insurance negotiated median rate for a Hip or knee replacement (inpatient stay) at Carilion New River Valley Medical Center is $72,722. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $41,053. Compared to the federal Medicare reimbursement reference rate of $14,044.15, this hospital’s rate is 5.18x the Medicare baseline. Located in 2900 Lamb Circle, Christiansburg, VA.

Cash / Self-Pay

$41,053

Average discount available for prompt cash payment at this facility.

Insurance Median

$72,722

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: $41,053 (292%)

Insurance Median: $72,722 (518%)

Cash: $41,053 (292% of Medicare)

Ins. Median: $72,722 (518% 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 518% of the Medicare baseline (a markup of 418%). 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 - $18,372	87%
Aetna	$16,931 - $77,883	121%
Blue Cross Blue Shield	$18,372 - $66,408	131%
UnitedHealthcare	$18,552 - $95,875	132%
Sentara Health Plan	$18,912 - $72,722	135%
Vhn - Ultra	$72,722	518%
Cigna	$79,056 - $84,451	563%
Gateway - Tier 3	$79,759	568%
Connecticare	$82,105	585%
Vhn - Plus	$90,316	643%
Gateway - Tier 2	$93,834	668%
Vhn	$93,834	668%
Vhn - Link	$105,564	752%
Gateway - Tier 1	$111,428	793%
Vhn - Secondary Payors	$111,428	793%

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 $41,053.
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 New River Valley 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.