CMS Price Transparency Data

Hip or knee replacement (inpatient stay)

Facility: Ascension Saint Thomas Hospital

Billing Code: 470 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 470
Insurance Median: $12,192
Cash Discount Price: Unavailable
vs. Medicare Baseline: 0.87x Medicare

The contracted insurance negotiated median rate for a Hip or knee replacement (inpatient stay) at Ascension Saint Thomas Hospital is $12,192. 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 0.87x the Medicare baseline. Located in 4220 Harding Rd, Po Box 380, Nashville, TN.

Cash / Self-Pay

Unavailable

Average discount available for prompt cash payment at this facility.

Insurance Median

$12,192

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: $12,192 (87%)

Ins. Median: $12,192 (87% 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
Amerigroup Mcaid Replacement	$7,610 - $9,671	54%
Oscar Health Plan	$8,150	58%
Oscar Health	$8,394	60%
Community Plan	$8,944	64%
Cigna	$9,450 - $26,957	67%
Amerigroup	$9,671	69%
Point Comfort Underwriters	$10,551	75%
Smart Health	$10,900 - $21,080	78%
Americhoice Mcr Replacement	$11,020	78%
Medicare (plans)	$11,020 - $12,309	78%
Tricare	$11,254	80%
Humana	$11,267 - $11,723	80%
UnitedHealthcare	$11,485 - $15,974	82%
Ascension Complete	$11,723	83%
Centurion Of Tn	$11,723	83%
Covid Uninsured Test Fund	$11,723	83%
Healthspring Mcr Replacement	$11,723	83%
Nhc Advantage	$11,723	83%
Triwest Va Pccc	$11,723	83%
Aetna	$11,957 - $43,688	85%
Amerigroup Mcr Replacement	$12,075	86%
Blue Cross Blue Shield	$12,192 - $56,674	87%
Phcs	$13,288	95%
Ambetter / Centene	$15,240	109%
Health 2 Business	$24,214 - $27,839	172%

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 Ascension Saint Thomas Hospital 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.