CMS Price Transparency Data

Hip or knee replacement (inpatient stay)

Facility: Baylor Scott and White Medical Center Lake Pointe

Billing Code: 470 (MS-DRG)

The BaseRate · fair price high confidence

A fair price for this

$21,011

about 1.5× the $14,044 Medicare rate · typically $15,361–$25,598

modeled estimate · not a bill or quote

What this hospital charges insurers

$18,346

Below the fair price — a good deal

about $2,665 under the fair price · 1.3× Medicare

Medicare pays $14,044 Fair price $21,011 This hospital $18,346

How we calculate the fair BaseRate →

How this hospital compares to other TX hospitals

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

Cheapest $8,277 Priciest $18,346

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

A fair price for a Hip or knee replacement (inpatient stay) is about $21,011 (about 1.5× the $14,044 Medicare rate). Baylor Scott and White Medical Center Lake Pointe charges insurers about $18,346 — below the fair price — a good deal. Located in Rowlett, TX.

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	$16,875 - $42,989	120%
Blue Cross Blue Shieldmajor	$15,114 - $27,279	108%
Aetnamajor	$34,763	248%
Cignamajor	$23,356 - $27,477	166%
Humanamajor	$14,674 - $34,953	104%
Ambetter (Centene)	$33,163	236%
Baylor Scott & White	$13,940 - $26,413	99%
Cigna HealthSpring	$15,408	110%
Health Net	$25,749	183%
Molina	$15,408	110%
+ 4 smaller / regional plans	$15,408 - $35,742

Government programs also on file: Medicaid, Military & VA.

Excludes 3 rental-network / third-party entries (e.g. Multiplan, PHCS) — these are pricing networks, not insurers.

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 Baylor Scott and White Medical Center Lake Pointe 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 Baylor Scott and White Medical Center Lake Pointe

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

Childrens Medical Ctr of Dallas · Dallas $8,277
Childrens Medical Center Plano · Plano $8,277
Yoakum Community Hospital · Yoakum $10,446
Coon Memorial Hospital · Dalhart $11,018
Dell Seton Med Center at the University of Tx · Austin $11,474
Northwest Hills Surgical Hospital · Austin $11,474
Ascension Seton Highland Lakes · Burnet $11,474
Ascension Seton Edgar B Davis · Luling $11,474

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