CMS Price Transparency Data
Hip or knee replacement (inpatient stay)
Facility: Mercy Hospital Fort Smith
Billing Code: 470 (MS-DRG)
Factual Cost Summary (Answer Capsule)
- CPT Billing Code: 470
- Insurance Median: $14,651
- Cash Discount Price: $21,431
- vs. Medicare Baseline: 1.04x Medicare
The contracted insurance negotiated median rate for a Hip or knee replacement (inpatient stay) at Mercy Hospital Fort Smith is $14,651. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $21,431. Compared to the federal Medicare reimbursement reference rate of $14,044.15, this hospital’s rate is 1.04x the Medicare baseline. Located in 7301 Rogers Ave, Fort Smith, AR.
Cash / Self-Pay
$21,431
Average discount available for prompt cash payment at this facility.
Insurance Median
$14,651
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: $21,431 (153%)
Insurance Median: $14,651 (104%)
Cash: $21,431 (153% of Medicare)
Ins. Median: $14,651 (104% 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 |
|---|---|---|
| Aetna | $8,809 - $20,446 | 63% |
| Humana | $8,809 - $18,417 | 63% |
| Medicaid / KanCare | $8,809 - $14,033 | 63% |
| Private Health Care Systems Contracted [320320] | $11,527 | 82% |
| Private Health Care Systems [20320] | $11,527 | 82% |
| Novasys Contracted [320285] | $13,039 - $14,033 | 93% |
| Ambetter / Centene | $14,033 | 100% |
| Home State Health Plan Contracted [320187] | $14,033 | 100% |
| American Health Advantage Of Mo Mcr [20264] | $14,651 | 104% |
| Blue Cross Blue Shield | $14,651 - $21,025 | 104% |
| Cross Timbers Hospice [20098] | $14,651 | 104% |
| Elara Caring Aspire Hospice Contracted [320433] | $14,651 | 104% |
| Elara Caring Aspire Hospice [20433] | $14,651 | 104% |
| Globalhealth Contracted [320145] | $14,651 | 104% |
| Halo Hcr Inc Hospice Contracted [320432] | $14,651 | 104% |
| Halo Hcr Inc Hospice [20432] | $14,651 | 104% |
| Independent Health [20197] | $14,651 | 104% |
| Jordan Valley Senior Care Pace [20515] | $14,651 | 104% |
| Kindful Hospice Contracted [320434] | $14,651 | 104% |
| Kindful Hospice [20434] | $14,651 | 104% |
| Medical Associates Health [20444] | $14,651 | 104% |
| Medicare (plans) | $14,651 - $16,109 | 104% |
| Mercy Hospice Okc [20252] | $14,651 | 104% |
| Pace Of The Ozarks [20518] | $14,651 | 104% |
| Provider Partners Health Plans Contracted [320450] | $14,651 | 104% |
| Qual Choice Contracted [320325] | $14,651 | 104% |
| Spina Bifida Hlthcare Benefit [20506] | $14,651 | 104% |
| Tribute Health Plan Mcr [20338] | $14,651 | 104% |
| UnitedHealthcare | $14,651 - $24,121 | 104% |
| Valir Pace [20503] | $14,651 | 104% |
| Wellfirst Health Mcr [20443] | $14,651 | 104% |
| Cherokee Nation Health Serv Contracted [320066] | $15,478 | 110% |
| Dept Of Veteran Affairs Contracted [320106] | $15,478 | 110% |
| Indian Health Service Contracted [320198] | $15,478 | 110% |
| Indian Health Service [20198] | $15,478 | 110% |
| Cigna | $15,778 - $22,007 | 112% |
| Tricare | $17,894 | 127% |
| Municipal Health Plan Contracted [320271] | $18,903 | 135% |
| Employers Health Coalition Contracted [320116] | $19,160 | 136% |
| Aither Health Contracted [320449] | $19,866 | 141% |
| Edison Health Solutions Contracted [320502] | $19,866 | 141% |
| Mercy Benefit Admin Contracted [320251] | $19,866 | 141% |
| Usable Contracted [320409] | $21,025 | 150% |
| United Medical Resources Contracted [320454] | $24,121 | 172% |
| Health Choice Contracted [320166] | $24,254 | 173% |
| Qual Choice Contracted [320324] | $24,694 | 176% |
| First Health Contracted [320128] | $24,773 | 176% |