CMS Price Transparency Data

Hip or knee replacement (inpatient stay)

Facility: Carilion Stonewall Jackson Hospital

Billing Code: 470 (MS-DRG)

The BaseRate · fair price medium confidence

A fair price for this

$19,278

about 1.4× the $14,044 Medicare rate · typically $10,995–$34,453

modeled estimate · not a bill or quote

What this hospital charges insurers

$8,878

Below the fair price — a good deal

about $10,400 under the fair price · 0.6× Medicare

Medicare pays $14,044 Fair price $19,278 This hospital $8,878 Cash price $20,304 Hospital's list price $58,013

How we calculate the fair BaseRate →

How this hospital compares to other VA hospitals

Lowest price of the 9 VA hospitals we have prices for — a strong deal.

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 $19,278 (about 1.4× the $14,044 Medicare rate). Carilion Stonewall Jackson Hospital charges insurers about $8,878, or about $20,304 in cash — below the fair price — a good deal. Located in Lexington, 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	$29,064 - $47,420	207%
Blue Cross Blue Shieldmajor	$5,596 - $6,216	40%
Aetnamajor	$29,529 - $38,520	210%
Cignamajor	$46,468	331%
Humanamajor	$12,160	87%
Sentara	$35,968	256%
+ 9 smaller / regional plans	$35,968 - $55,112

Excludes 1 rental-network / third-party entry (e.g. Multiplan, PHCS) — these are pricing networks, not insurers.

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 20,304), 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 Stonewall Jackson Hospital 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 Stonewall Jackson Hospital

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

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
Carilion Medical Center · Roanoke $16,884

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