CMS Price Transparency Data

Hip or knee replacement (inpatient stay)

Facility: Southern Tennessee Regional Health System Lawrence

Billing Code: 470 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 470
Insurance Median: $15,418
Cash Discount Price: $19,731
vs. Medicare Baseline: 1.10x Medicare

The contracted insurance negotiated median rate for a Hip or knee replacement (inpatient stay) at Southern Tennessee Regional Health System Lawrence is $15,418. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $19,731. Compared to the federal Medicare reimbursement reference rate of $14,044.15, this hospital’s rate is 1.10x the Medicare baseline. Located in 1607 South Locust Avenue, Lawrenceburg, TN.

Cash / Self-Pay

$19,731

Average discount available for prompt cash payment at this facility.

Insurance Median

$15,418

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: $19,731 (140%)

Insurance Median: $15,418 (110%)

Cash: $19,731 (140% of Medicare)

Ins. Median: $15,418 (110% 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
Aetna	$2,043	15%
Cigna	$2,287	16%
UnitedHealthcare	$3,234 - $15,418	23%
Humana	$3,765 - $15,418	27%
Blue Cross Blue Shield	$15,115 - $25,735	108%
Medicare (plans)	$15,115	108%
Sterling	$15,115	108%
Devoted Health	$15,569	111%
Tennessee Rural Health Improvement Association	$15,569	111%
Windsor Health	$15,871	113%
Signature Health	$16,022	114%
Tricare	$18,684	133%

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 $19,731.
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 Southern Tennessee Regional Health System Lawrence 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.