CMS Price Transparency Data

Hip or knee replacement (inpatient stay)

Facility: Saint Thomas Highlands Hospital

Billing Code: 470 (MS-DRG)

The BaseRate · fair price high confidence

A fair price for this

$14,921

about 1.1× the $14,044 Medicare rate · typically $14,419–$21,295

modeled estimate · not a bill or quote

What this hospital charges insurers

$15,002

About the fair price

about $81 over the fair price · 1.1× Medicare

Medicare pays $14,044 Fair price $14,921 This hospital $15,002

How we calculate the fair BaseRate →

How this hospital compares to other TN hospitals

Highest price of the 9 TN hospitals we have prices for — worth calling around.

Cheapest $7,429 Priciest $15,002

Black dot = this hospital, among the 9 TN hospitals with a price for this procedure. Full list below.

A fair price for a Hip or knee replacement (inpatient stay) is about $14,921 (about 1.1× the $14,044 Medicare rate). Saint Thomas Highlands Hospital charges insurers about $15,002 — about the fair price. Located in Sparta, TN.

What each insurance company pays

Which insurers have negotiated a price with this hospital for this procedure — and which haven’t.

5 of 6 major insurers have a published price at this hospital

✓ UnitedHealthcare✓ Blue Cross Blue Shield✓ Aetna✓ Cigna✓ Humana Kaiser Permanente

Crossed out = this hospital hasn’t published a negotiated price for that insurer for this procedure. It doesn’t necessarily mean they aren’t accepted — ask your insurer.

Insurance company	Price range	vs. Medicare
UnitedHealthcaremajor	$11,485 - $15,974	82%
Blue Cross Blue Shieldmajor	$6,156 - $51,663	44%
Aetnamajor	$14,785 - $43,688	105%
Cignamajor	$9,564 - $26,957	68%
Humanamajor	$14,495	103%
Ambetter (Centene)	$18,843	134%
Amerigroup	$7,610 - $14,495	54%
Cigna HealthSpring	$14,495	103%
Oscar Health	$8,394 - $9,510	60%
+ 7 smaller / regional plans	$8,944 - $27,839

Government programs also on file: Medicare.

Self-Pay How to get the cash price

Tell the billing desk you want to be billed as self-pay — not through insurance — before your visit.
Ask for the cash / prompt-pay discount in writing, with the exact price, before you agree to anything.
Get it in writing that they won’t also bill your insurance, so the cash price is what you owe.
Check the MS-DRG code on your bill matches exactly: 470.

Insurance Before you use insurance

Call your insurance company to confirm Saint Thomas Highlands Hospital is in-network.
Ask your insurer whether prior approval is required for MS-DRG code 470.
Confirm the doctor or provider is in-network too — not just the hospital building.
Check your Explanation of Benefits against the hospital’s final itemized bill.

Estimate your out-of-pocket cost

A rough estimate of what you’d pay with insurance (deductible + coinsurance) versus paying the cash price yourself.

How you’d pay

Deductible left to meet ($)

Your coinsurance (%)

Enter your details and press estimate to compare.

Other Procedures at Saint Thomas Highlands Hospital

Compare: Hip or knee replacement (inpatient stay) at other TN hospitals

Unity Medical Center · Manchester $7,429
Southern Tennessee Regional Health System Winchest · Winchester $13,087
Parkwest Medical Center · Knoxville $13,222
Ascension Saint Thomas Hospital · Nashville $13,288
Highpoint Health-Sumner With Ascension Saint Thoma · Gallatin $13,369
Physicians Regional Medical Center · Powell $13,846
Dekalb Community Hospital · Smithville $13,948
Morristown Hamblen Hospital Association · Morristown $13,961

Insurance negotiated median for the same procedure, sorted lowest first.