North Carolina / North Carolina Specialty Hospital
CMS certification 340049 · Durham, NC
North Carolina Specialty Hospital: charges and Medicare payments
North Carolina Specialty Hospital reported 87 Medicare inpatient stays across 4 DRGs in 2024. Across them it charged 3.74 times what it was paid. Its most frequent stay was DRG 470, Major Hip and Knee Joint Replacement or Reattachment of Lower Extremity without MCC: 40 stays at an average charge of $42,319, 55% below the national average. It also billed 1,519 outpatient services, charging 4.02 times what Medicare paid.
- 1Medicare inpatient stays 87
- 2Charge ÷ paid, inpatient 3.74×
- 3Rank in NC (highest ratio = 1) –
- 4CMS price-transparency actions 0
Inpatient stays
For the 4 DRGs that can be compared with the national average, North Carolina Specialty Hospital charged more than the national average in 0 (0%). Payments follow Medicare's rates, so they usually vary far less than charges.
| DRG | Stays | Avg charge | vs US | Avg paid |
|---|---|---|---|---|
| 470 Major Hip and Knee Joint Replacement or Reattachment of... | 40 | $42,319 | -55% | $12,492 |
| 468 Revision of Hip or Knee Replacement without CC/MCC | 22 | $82,345 | -34% | $20,257 |
| 483 Major Joint or Limb Reattachment Procedures of Upper... | 13 | $65,594 | -48% | $16,519 |
| 455 Combined Anterior and Posterior Spinal Fusion without CC/MCC | 12 | $123,917 | -39% | $33,463 |
Outpatient services
| Service (APC) | Services | Avg charge | Medicare allowed |
|---|---|---|---|
| Level 1 Intraocular Procedures | 591 | $5,202 | $2,084 |
| Level 5 Musculoskeletal Procedures | 415 | $40,601 | $11,671 |
| Level 4 Musculoskeletal Procedures | 122 | $26,436 | $6,453 |
| Level 6 Musculoskeletal Procedures | 87 | $62,422 | $16,281 |
| Level 3 Urology and Related Services | 51 | $2,822 | $1,837 |
| Level 1 Nerve Procedures | 43 | $8,679 | $1,709 |
| Level 2 Intraocular Procedures | 42 | $10,564 | $3,668 |
| Level 3 Musculoskeletal Procedures | 36 | $8,898 | $2,890 |
| Level 3 Extraocular, Repair, and Plastic Eye Procedures | 25 | $3,450 | $2,108 |
| Level 3 Intraocular Procedures | 23 | $12,128 | $4,714 |
| Level 1 Laparoscopy and Related Services | 17 | $11,797 | $5,204 |
| Level 4 Urology and Related Services | 15 | $10,002 | $3,144 |
| Level 2 Musculoskeletal Procedures | 14 | $2,835 | $1,450 |
| Level 1 Abdominal/Peritoneal/Biliary and Related Procedures | 14 | $8,898 | $3,121 |
| Level 2 Excision/ Biopsy/ Incision and Drainage | 12 | $4,206 | $1,462 |
| Level 2 Neurostimulator and Related Procedures | 12 | $29,890 | $6,169 |
Against the North Carolina average
For Major Hip and Knee Joint Replacement or Reattachment of Lower Extremity without MCC (DRG 470), North Carolina Specialty Hospital charged $42,319 on average, 40% less than the North Carolina average of $70,932, and was paid $12,492 against a state average of $15,577. For Revision of Hip or Knee Replacement without CC/MCC (DRG 468), North Carolina Specialty Hospital charged $82,345 on average, 25% less than the North Carolina average of $109,394, and was paid $20,257 against a state average of $22,266. For Major Joint or Limb Reattachment Procedures of Upper Extremities (DRG 483), North Carolina Specialty Hospital charged $65,594 on average, 35% less than the North Carolina average of $101,208, and was paid $16,519 against a state average of $21,390. For Combined Anterior and Posterior Spinal Fusion without CC/MCC (DRG 455), North Carolina Specialty Hospital charged $123,917 on average, 28% less than the North Carolina average of $172,728, and was paid $33,463 against a state average of $39,556. For Level 1 Intraocular Procedures (outpatient APC 5491), its average charge of $5,202 was 49% below the state average of $10,153. For Level 5 Musculoskeletal Procedures (outpatient APC 5115), its average charge of $40,601 was 34% below the state average of $61,166. For Level 4 Musculoskeletal Procedures (outpatient APC 5114), its average charge of $26,436 was 32% below the state average of $38,985. For Level 6 Musculoskeletal Procedures (outpatient APC 5116), its average charge of $62,422 was 29% below the state average of $87,442.
Price-transparency record
No action in CMS's price-transparency enforcement list (July 2026) matches this hospital's exact name, city and state. That can mean CMS has not reviewed it, or that it is listed under a different name.
Charges are the hospital's list prices averaged over its 2024 Medicare cases; payments are what those cases actually brought in. Neither is what you will pay. For a planned procedure, ask the hospital for its price estimate or, if you are uninsured or self-paying, a good-faith estimate.
Sources: CMS Medicare Inpatient Hospitals — by Provider and Service / by Geography and Service, data year 2024; CMS Medicare Outpatient Hospitals — by Provider and Service / by Geography and Service, data year 2024; CMS Hospital Price Transparency Enforcement Activities and Outcomes, July 2026. Checked 2026-10-24. Methodology.