CMS Price Transparency Data

Hip or knee replacement (inpatient stay)

Facility: Tristar Horizon Medical Center

Billing Code: 470 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 470
Insurance Median: $15,521
Cash Discount Price: Unavailable
vs. Medicare Baseline: 1.11x Medicare

The contracted insurance negotiated median rate for a Hip or knee replacement (inpatient stay) at Tristar Horizon Medical Center is $15,521. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is unavailable. Compared to the federal Medicare reimbursement reference rate of $14,044.15, this hospital’s rate is 1.11x the Medicare baseline. Located in 111 Highway 70 East, Dickson, TN.

Cash / Self-Pay

Unavailable

Average discount available for prompt cash payment at this facility.

Insurance Median

$15,521

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%)

Insurance Median: $15,521 (111%)

Ins. Median: $15,521 (111% 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.

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
Prime Health	$2,253	16%
Novanet	$2,300	16%
United	$3,271 - $37,214	23%
Corvel Corporation	$3,450	25%
Blue Cross Blue Shield	$6,101 - $61,118	43%
Wellpoint	$10,500	75%
Alive Hospice, Inc.	$14,456	103%
Bright Health	$15,065 - $19,605	107%
Amerigroup	$15,217	108%
Humana	$15,217 - $24,242	108%
Sarah Cannon Research	$15,217	108%
Ambetter / Centene	$15,246 - $15,856	109%
Aetna	$15,369 - $47,887	109%
Devoted Health Plan	$15,521	111%
Healthspring	$15,521	111%
Signature Advantage	$15,521	111%
Apex Health	$15,673	112%
Evergreen Hmo	$15,673	112%
Wellcare	$15,673	112%
Atrio Golden Times	$15,826	113%
Nhc Advantage, Inc.	$15,826	113%
Pruitt Health (Allyalign)	$15,826	113%
American Health Advantage	$15,978	114%
Zing	$16,739	119%
Cigna	$18,507 - $21,031	132%
Oscar	$22,178	158%

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 $X.
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 Tristar Horizon 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.