CMS Price Transparency Data

Hip or knee replacement (inpatient stay)

Facility: Tristar Southern Hills Medical Center

Billing Code: 470 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 470
Insurance Median: $18,965
Cash Discount Price: Unavailable
vs. Medicare Baseline: 1.35x Medicare

The contracted insurance negotiated median rate for a Hip or knee replacement (inpatient stay) at Tristar Southern Hills Medical Center is $18,965. 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 1.35x the Medicare baseline. Located in 391 Wallace Rd, Nashville, TN.

Cash / Self-Pay

Unavailable

Average discount available for prompt cash payment at this facility.

Insurance Median

$18,965

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: $18,965 (135%)

Ins. Median: $18,965 (135% 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	$2,987 - $33,819	21%
Corvel Corporation	$3,450	25%
Blue Cross Blue Shield	$8,619 - $66,535	61%
Wellpoint	$13,144	94%
Ambetter / Centene	$15,246 - $15,856	109%
Bright Health	$15,814 - $19,605	113%
Alive Hospice, Inc.	$17,839	127%
Cigna	$18,507 - $21,031	132%
Amerigroup	$18,777	134%
Humana	$18,777 - $24,242	134%
Odyssey Healthcare	$18,777	134%
Sarah Cannon Research	$18,777	134%
Aetna	$18,965 - $47,887	135%
Devoted Health Plan	$19,153	136%
Healthspring	$19,153	136%
Wellcare	$19,341	138%
Nhc Advantage, Inc.	$19,529	139%
American Health Advantage	$19,716	140%
Evergreen Hmo	$19,716	140%
Signature Advantage	$19,716	140%
Apex Health	$19,904	142%
Atrio Golden Times	$20,092	143%
Pruitt Health (Allyalign)	$20,092	143%
Zing	$20,655	147%
Oscar	$22,178	158%
Multiplan	$30,170	215%

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 Southern Hills 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.