Cornerstone Precision Manufacturing (Plano, TX) is a 487-employee self-insured employer covered under an Aetna Choice POS II PPO contract. The plan provides unrestricted in-network access to 38 hospital facilities and over 2,400 physicians across the Dallas–Fort Worth metropolitan area (CBSA 19100), with a $1,500 individual deductible and 80/20 coinsurance after deductible. The plan design includes no tiered network provisions, no Center of Excellence steerage requirements, and no utilization-based incentives to direct members toward lower-cost facilities. Benchmarking the plan's negotiated rates against 142 group market plans operating in the same geography — using CMS Transparency in Coverage Machine-Readable File data through March 2026 — places the employer at the 68th market percentile, meaning Aetna's contracted rates for this plan exceed those of 68 out of every 100 comparable group plans in the DFW market. Across 25 high-frequency procedure codes, the analysis identifies $312,400 in annualized overpayment relative to market median rates across 38 in-network hospital NPIs.
| Category | Key Codes | Your Avg. Rate | Mkt Median | Est. Annual Savings |
|---|---|---|---|---|
Orthopedic Surgery
Joint replacement — highest per-case dollar variance in DFW |
DRG 470CPT 27447CPT 27130 | $28,500 | $22,200 | $148,200 |
Advanced Imaging
MRI and CT — significant facility-level rate variance in market |
CPT 70553CPT 71250 | $2,650 | $1,560 | $67,800 |
Cardiovascular Procedures
Drug-eluting stent — 82nd percentile in DFW market |
DRG 247 | $42,600 | $35,400 | $63,400 |
Office & Ancillary Services
14 additional codes at or above market median — high utilization volume |
CPT 43239CPT 45378CPT 93306+11 | — | — | $33,000 |
| Total Identified Savings Opportunity (vs. market median) | $312,400 / yr | |||
| Code | Procedure | Setting | Your Rate | Mkt P10 | Mkt Median | Mkt P90 | Your %ile | Sav./Case |
|---|---|---|---|---|---|---|---|---|
| Inpatient — MS-DRG · sorted ascending by code | ||||||||
| 194 | Simple pneumonia & pleurisy with CC | IP | $12,400 | $8,200 | $13,600 | $21,800 | 46th | — |
| 247 | Perc cardiovasc proc w/ drug-eluting stent | IP | $42,600 | $24,800 | $35,400 | $52,100 | 82nd | $7,200 |
| 291 | Heart failure & shock with MCC | IP | $28,400 | $16,200 | $24,100 | $38,900 | 72nd | $4,300 |
| 378 | GI hemorrhage with CC | IP | $11,200 | $7,100 | $12,800 | $19,400 | 44th | — |
| 392 | Esophagitis, gastroenteritis w/o MCC | IP | $9,200 | $6,800 | $11,400 | $18,200 | 42nd | — |
| 470 | Major hip & knee joint replacement | IP | $34,200 | $18,400 | $26,800 | $41,200 | 78th | $7,400 |
| 603 | Cellulitis without MCC | IP | $8,100 | $5,400 | $9,800 | $15,600 | 44th | — |
| 641 | Misc disorders of nutrition, metabolism | IP | $14,600 | $8,900 | $13,100 | $21,200 | 68th | $1,500 |
| 683 | Renal failure with CC | IP | $16,800 | $9,400 | $14,200 | $23,400 | 76th | $2,600 |
| 871 | Septicemia w/o MV >96 hrs with MCC | IP | $19,800 | $12,100 | $21,400 | $34,600 | 48th | — |
| Outpatient — CPT / HCPCS · sorted ascending by code | ||||||||
| 27130 | Total hip arthroplasty | OP | $24,800 | $13,400 | $19,200 | $29,600 | 82nd | $5,600 |
| 27447 | Total knee arthroplasty | OP | $26,400 | $14,200 | $20,600 | $31,800 | 84th | $5,800 |
| 36415 | Venipuncture, routine | OP | $22 | $12 | $18 | $32 | 68th | — |
| 43239 | Upper GI endoscopy with biopsy | OP | $1,840 | $980 | $1,520 | $2,340 | 76th | $320 |
| 45378 | Colonoscopy, diagnostic | OP | $2,120 | $1,140 | $1,780 | $2,680 | 78th | $340 |
| 70553 | MRI brain with contrast | OP | $2,840 | $980 | $1,640 | $2,980 | 88th | $1,200 |
| 71046 | Chest X-ray, 2 views | OP | $142 | $62 | $98 | $164 | 78th | $44 |
| 71250 | CT thorax without contrast | OP | $2,460 | $820 | $1,480 | $2,640 | 86th | $980 |
| 80053 | Comprehensive metabolic panel | OP | $68 | $28 | $52 | $94 | 74th | $16 |
| 85025 | Complete blood count with differential | OP | $48 | $18 | $36 | $68 | 72nd | $12 |
| 93000 | Electrocardiogram, routine | OP | $82 | $38 | $64 | $108 | 76th | $18 |
| 93306 | Echo transthoracic with spectral doppler | OP | $1,840 | $980 | $1,540 | $2,480 | 76th | $300 |
| 99213 | Office visit, established, low complexity | OP | $124 | $78 | $108 | $168 | 72nd | $16 |
| 99214 | Office visit, established, moderate complexity | OP | $186 | $112 | $158 | $234 | 74th | $28 |
| 99232 | Subsequent hospital care, low complexity | OP | $168 | $98 | $148 | $224 | 64th | $20 |
Your plan's negotiated rate compared to three competing payers at each of the employer's three highest-utilization DFW hospitals, for the five highest-spend procedure codes at each facility. Bold blue = your plan has the highest published rate at that hospital for that code. Italic = your plan is not the highest payer.
| Hospital & Procedure | Your Rate (Aetna) | Cigna OAP | BCBS TX Blue Adv. | UHC Choice Plus |
|---|---|---|---|---|
| Medical City Dallas · NPI 1144224416 · Dallas, TX 75230 · 247-bed tertiary care | ||||
| DRG 247 Cardiovascular — drug-eluting stent | $42,600 | $37,200 | $34,800 | $44,100 |
| DRG 470 Major joint replacement | $34,200 | $28,400 | $26,100 | $36,800 |
| CPT 27447 Total knee arthroplasty | $26,400 | $21,800 | $19,600 | $28,200 |
| CPT 70553 MRI brain with contrast | $2,840 | $1,920 | $1,640 | $2,100 |
| CPT 71250 CT thorax without contrast | $2,460 | $1,820 | $1,520 | $2,180 |
| Baylor Scott & White Medical Center — Plano · NPI 1003892461 · Plano, TX 75093 · 116-bed community hospital | ||||
| DRG 470 Major joint replacement | $31,800 | $27,200 | $24,900 | $29,400 |
| CPT 27130 Total hip arthroplasty | $28,600 | $23,400 | $21,200 | $26,100 |
| CPT 27447 Total knee arthroplasty | $24,600 | $20,400 | $18,800 | $22,100 |
| CPT 70553 MRI brain with contrast | $2,480 | $1,760 | $1,540 | $2,640 |
| CPT 71250 CT thorax without contrast | $2,460 | $1,620 | $1,380 | $2,180 |
| UT Southwestern Medical Center · NPI 1831182708 · Dallas, TX 75390 · 460-bed academic medical center | ||||
| DRG 247 Cardiovascular — drug-eluting stent | $38,400 | $32,600 | $30,200 | $40,100 |
| DRG 470 Major joint replacement | $29,400 | $24,800 | $22,600 | $31,200 |
| CPT 70553 MRI brain with contrast | $2,620 | $1,480 | $1,320 | $1,840 |
| CPT 71250 CT thorax without contrast | $2,280 | $1,240 | $1,080 | $1,580 |
| CPT 45378 Colonoscopy, diagnostic | $2,120 | $1,640 | $1,420 | $1,880 |
Estimated annual savings if the employer switched to an alternative payer at next renewal. Based on published in-network rates at the same 38 NPIs, assuming identical utilization pattern as the prior plan year. Network coverage percentage reflects the share of the employer's in-use provider zip codes covered by each alternative payer.
| Procedure | Aetna (Current) | BCBS TX | Savings / Case |
|---|---|---|---|
| DRG 470 — Joint replacement | $34,200 | $26,100 | $8,100 |
| CPT 27447 — Total knee | $26,400 | $19,600 | $6,800 |
| CPT 70553 — MRI brain | $2,840 | $1,640 | $1,200 |
| DRG 247 — Cardiovasc. stent | $42,600 | $34,800 | $7,800 |
| Procedure | Aetna (Current) | Cigna | Savings / Case |
|---|---|---|---|
| DRG 470 — Joint replacement | $34,200 | $28,400 | $5,800 |
| CPT 27447 — Total knee | $26,400 | $21,800 | $4,600 |
| CPT 70553 — MRI brain | $2,840 | $1,920 | $920 |
| DRG 247 — Cardiovasc. stent | $42,600 | $37,200 | $5,400 |