What this sample shows: A real pricing disparity analysis using published hospital data — the kind of exhibit attorneys use to challenge inflated charges, support lien negotiations, and strengthen case evaluations.
Subject Hospital: Dell Seton Medical Center at The University of TX, Austin, TX
Procedure: Total Knee Replacement (CPT 27447)
Data Source: CMS Hospital Price Transparency Machine-Readable Files (45 CFR 180)
| Payer | Negotiated Rate | vs. Lowest Market Rate | Disparity |
|---|---|---|---|
| Humana PPO | $23,122.75 | $1,894.00 (Seton Williamson) | 1,121% |
| Humana HMO | $20,564.25 | $1,894.00 (Seton Williamson) | 986% |
| UHC | $14,111.76 | $1,894.00 (Seton Williamson) | 645% |
| Aetna Whole Health | $12,401.29 | $1,901.57 (Seton Hays) | 552% |
| BCBS Preferred | $9,470.28 | $7,420.49 (Seton Williamson) | 28% |
| Hospital | City | UHC Negotiated Rate |
|---|---|---|
| Ascension Seton Highland Lakes | Burnet | $32,093.00 |
| Ascension Seton Smithville | Smithville | $32,093.00 |
| Ascension Seton Northwest | Austin | $27,040.00 |
| Dell Seton Med Center (Subject) | Austin | $14,111.76 |
| Ascension Seton Hays | Kyle | $1,901.57 |
| Ascension Seton Williamson | Round Rock | $1,894.00 |
| Data Source | CMS Hospital Price Transparency Machine-Readable Files |
| Legal Authority | 45 CFR 180 (Hospital Price Transparency Rule) |
| Hospitals Tracked | 2,000+ across 10 states |
| Total Rates in Database | 1.2 billion+ |
| Data Refresh | Daily monitoring, weekly full update |
| Report Date | April 1, 2026 |
A 645% pricing disparity for the same procedure, same payer, at hospitals 18 miles apart is difficult to justify as reasonable and customary. This type of data supports lien reduction arguments, informs settlement negotiations, and provides a factual basis for challenging inflated medical charges. The hospital's own published filings are the source — not estimates.
| Data Source | CMS Hospital Price Transparency Machine-Readable Files (45 CFR 180) — hospitals' own mandatory filings |
| Comparison Basis | Same CPT code (27447), same payer, across all hospitals within the subject hospital's metro area |
| Data Freshness | Hospital files monitored daily. Rates in this exhibit reflect the most recent available filing as of the report date. |
| Limitations | Negotiated rates may not reflect final patient cost (deductibles, copays apply). Some hospitals may not publish all payer contracts. Rates represent amounts agreed between hospital and payer, not billed charges. |
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