CMS Price Transparency Data

Hip or knee replacement (inpatient stay)

Facility: Charleston Area Medical Center

Billing Code: 470 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 470
Insurance Median: $34,504
Cash Discount Price: $123,790
vs. Medicare Baseline: 2.46x Medicare

The contracted insurance negotiated median rate for a Hip or knee replacement (inpatient stay) at Charleston Area Medical Center is $34,504. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $123,790. Compared to the federal Medicare reimbursement reference rate of $14,044.15, this hospital’s rate is 2.46x the Medicare baseline. Located in 501 Morris Street, Charleston, WV.

Cash / Self-Pay

$123,790

Average discount available for prompt cash payment at this facility.

Insurance Median

$34,504

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: $123,790 (881%)

Insurance Median: $34,504 (246%)

Cash: $123,790 (881% of Medicare)

Ins. Median: $34,504 (246% 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 246% of the Medicare baseline (a markup of 146%). 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
Aetna	$11,143 - $121,314	79%
The Health Plan Of West Virginia Inc.	$11,143 - $120,076	79%
Unicare Health Plan Of West Virginia Inc.	$11,143	79%
Triwest Va	$11,953	85%
Blue Cross Blue Shield	$12,323 - $112,884	88%
Choicecare Network	$12,323 - $121,314	88%
Optimum Choice Inc.	$12,323	88%
UnitedHealthcare	$12,692 - $121,314	90%
West Virginia Senior Advantage Inc.	$12,939	92%
Integrated Medical Solutions	$17,868	127%
Naphcare	$24,646	175%
Caresource	$34,504	246%
Tricare	$74,274	529%
City Of Charleston	$92,842	661%
Cigna	$115,125	820%
Three Rivers Providers Network	$120,076	855%
Healthsmart	$121,314	864%
Multiplan	$121,314	864%

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 $123,790.
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 Charleston Area 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.