CMS Price Transparency Data

Hip or knee replacement (inpatient stay)

Facility: Ascension Seton Southwest

Billing Code: 470 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 470
Insurance Median: $12,085
Cash Discount Price: Unavailable
vs. Medicare Baseline: 0.86x Medicare

The contracted insurance negotiated median rate for a Hip or knee replacement (inpatient stay) at Ascension Seton Southwest is $12,085. 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 0.86x the Medicare baseline. Located in 7900 Fm 1826, Austin, TX.

Cash / Self-Pay

Unavailable

Average discount available for prompt cash payment at this facility.

Insurance Median

$12,085

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: $12,085 (86%)

Ins. Median: $12,085 (86% 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
Humana	$4,701 - $12,085	33%
Seton Performance Plus	$4,937	35%
Medicare (plans)	$6,150 - $12,085	44%
Blue Cross Blue Shield	$6,318 - $8,368	45%
Cigna	$6,863	49%
Whole Foods	$9,063	65%
Oscar Health Exchange	$9,379	67%
UnitedHealthcare	$11,474 - $13,993	82%
Aarp Mc Wellmed	$11,844	84%
Sendero Chap	$11,964	85%
Addr Cancer Together	$12,085	86%
Aetna	$12,085	86%
Covid Hrsa	$12,085	86%
Cshcn Cidc	$12,085	86%
Devoted Health Mcr Replacement	$12,085	86%
Research Study	$12,085	86%
Smarthealth	$12,085	86%
Superior Allwell	$12,085	86%
Tricare	$12,085 - $13,007	86%
Wellcare Med Advantage	$12,085	86%
Connected Senior Care	$12,448	89%
Pphp Mcr Advantage	$12,689	90%
Tx Independence Hp	$12,689	90%
Occunet	$16,919	120%
Sendero Idealcare	$21,149	151%
Ambetter / Centene	$21,753	155%

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 Ascension Seton Southwest 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.