CMS Price Transparency Data

Hip or knee replacement (inpatient stay)

Facility: Baylor University Medical Center

Billing Code: 470 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 470
Insurance Median: $20,637
Cash Discount Price: Unavailable
vs. Medicare Baseline: 1.47x Medicare

The contracted insurance negotiated median rate for a Hip or knee replacement (inpatient stay) at Baylor University Medical Center is $20,637. 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 1.47x the Medicare baseline. Located in 3500 Gaston Ave, Dallas, TX.

Cash / Self-Pay

Unavailable

Average discount available for prompt cash payment at this facility.

Insurance Median

$20,637

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: $20,637 (147%)

Ins. Median: $20,637 (147% 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
Baylor Scott & White Health Plan	$14,084 - $30,956	100%
University Of Mary Hardin-Baylor	$16,225	116%
Aetna	$17,198 - $34,763	122%
Humana	$17,198 - $34,953	122%
Triwest	$17,198	122%
Wellpoint (Fka Amerigroup)	$17,714	126%
Corvel	$18,016	128%
Prime Health Services	$18,016	128%
American Health Plan	$18,058	129%
Blue Cross Blue Shield	$18,058 - $29,326	129%
Healthspring	$18,058	129%
Molina	$18,058	129%
Procare Advantage	$18,058	129%
Superior Health Plan	$18,058	129%
UnitedHealthcare	$19,777 - $40,161	141%
Cigna	$23,356 - $27,477	166%
Employers Health Network	$25,749	183%
Healthsmart	$34,290 - $36,028	244%
Private Health Care System	$35,742	254%
Ambetter / Centene	$38,867	277%

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 Baylor University 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.