CMS Price Transparency Data
Hip or knee replacement (inpatient stay)
Facility: Methodist Southlake Medical Center
Billing Code: 470 (MS-DRG)
Factual Cost Summary (Answer Capsule)
- CPT Billing Code: 470
- Insurance Median: $21,413
- Cash Discount Price: $30,056
- vs. Medicare Baseline: 1.52x Medicare
The contracted insurance negotiated median rate for a Hip or knee replacement (inpatient stay) at Methodist Southlake Medical Center is $21,413. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $30,056. Compared to the federal Medicare reimbursement reference rate of $14,044.15, this hospital’s rate is 1.52x the Medicare baseline. Located in 421 E State Highway 114, Southlake, TX.
Cash / Self-Pay
$30,056
Average discount available for prompt cash payment at this facility.
Insurance Median
$21,413
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%)
Cash / Self-Pay: $30,056 (214%)
Insurance Median: $21,413 (152%)
Cash: $30,056 (214% of Medicare)
Ins. Median: $21,413 (152% 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.
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 |
|---|---|---|
| UnitedHealthcare | $4,763 - $22,260 | 34% |
| Aetna | $13,815 - $32,787 | 98% |
| Blue Cross Blue Shield | $13,815 - $47,017 | 98% |
| Medicare (plans) | $13,815 - $14,782 | 98% |
| Ust Health Proof [1005] | $13,815 | 98% |
| Wellcare [7016] | $13,815 | 98% |
| American Health Advantage Of Texas [7099] | $14,506 | 103% |
| Cigna | $14,506 - $21,683 | 103% |
| Globalhealth [1003] | $14,506 | 103% |
| Procare Advantage [7018] | $14,506 | 103% |
| Humana | $14,644 | 104% |
| Southwestern Health Resources Swhr [7015] | $14,644 | 104% |
| Medicaid / KanCare | $14,689 - $38,630 | 105% |
| Provider Partners Health Plan [7025] | $15,197 | 108% |
| Mcs Advantage, Inc Classicare [7021] | $15,611 | 111% |
| Medical Card System [2063] | $15,611 | 111% |
| Alternative Service Concepts [8005] | $17,269 | 123% |
| Oscar Insurance Company [2057] | $19,341 | 138% |
| Bright Healthcare [2222] | $19,502 | 139% |
| Department Of Labor [8004] | $19,756 | 141% |
| Generic Workers Comp Tx Non Par [9010] | $19,756 | 141% |
| Generic Workers Comp Tx Par [8002] | $19,756 | 141% |
| Generic Workers Comp Tx Par [9011] | $19,756 | 141% |
| Tristar Risk Management [8006] | $19,756 | 141% |
| Champva [1000] | $19,833 | 141% |
| Tricare | $19,833 | 141% |
| Triwest Wps [8010] | $19,833 | 141% |
| Veterans Administration [9001] | $19,833 | 141% |
| Molina [3017] | $20,032 | 143% |
| Sana Benefits [3069] | $20,723 | 148% |
| Wellpoint Marketplace Exchange [3071] | $21,413 | 152% |
| Web Tpa [3049] | $21,683 - $32,787 | 154% |
| Bind Benefits Inc [1004] | $22,260 | 159% |
| Definity Health [3006] | $22,260 | 159% |
| Freedom Life Insurance Company [2029] | $22,260 | 159% |
| Geha Federal [3066] | $22,260 | 159% |
| Tml Intergovernmental Employee Benefits [3050] | $22,260 | 159% |
| 90 Degree Benefit [3057] | $22,795 | 162% |
| Allied National [2031] | $22,795 | 162% |
| Entrust/90 Degree [2058] | $22,795 | 162% |
| Kempton Group Administrators, Tower Extrusions [3061] | $23,147 | 165% |
| Friday Health Plan [2061] | $23,486 | 167% |
| Ambetter / Centene | $23,624 | 168% |
| Imperial Insurance Companies [3073] | $24,867 | 177% |
| Scott & White Health Plan Trs [3062] | $28,112 | 200% |
| Evry Health [1013] | $34,538 | 246% |
| Health Plans Inc [5017] | $34,538 | 246% |
| Medical Cost Containment Professionals [3059] | $34,538 | 246% |
| Velocity [3070] | $34,538 | 246% |
| Dart Member Care [3039] | $37,301 | 266% |
| Healthscope Benefits [2052] | $37,301 | 266% |
| Healthscope Benefits [3063] | $37,301 | 266% |