CMS Price Transparency Data

Hip or knee replacement (inpatient stay)

Facility: Tristar Northcrest Medical Center

Billing Code: 470 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 470
Insurance Median: $15,061
Cash Discount Price: Unavailable
vs. Medicare Baseline: 1.07x Medicare

The contracted insurance negotiated median rate for a Hip or knee replacement (inpatient stay) at Tristar Northcrest Medical Center is $15,061. 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 1.07x the Medicare baseline. Located in 100 Northcrest Drive, Springfield, TN.

Cash / Self-Pay

Unavailable

Average discount available for prompt cash payment at this facility.

Insurance Median

$15,061

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: $15,061 (107%)

Ins. Median: $15,061 (107% 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
United	$2,091 - $32,913	15%
Prime Health	$2,253	16%
Novanet	$2,300	16%
Wellpoint	$10,336	74%
Alive Hospice	$13,289	95%
Molina	$14,027	100%
Wellcare	$14,027 - $14,766	100%
Bright Health	$14,618 - $19,605	104%
Amerigroup	$14,766	105%
Humana	$14,766 - $24,242	105%
Aetna	$14,913 - $47,887	106%
Devoted Health Plan	$15,061	107%
Healthspring	$15,061	107%
Evergreen Hmo	$15,209	108%
Ambetter / Centene	$15,246 - $15,856	109%
Atrio Golden Times	$15,356	109%
Blue Cross Blue Shield	$15,356 - $26,514	109%
Nhc Advantage, Inc.	$15,356	109%
American Health Advantage	$15,504	110%
Zing	$16,242	116%
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 Northcrest 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.