Hip or knee replacement (inpatient stay)
Facility: Mercy Hospital Pittsburg, Inc
Billing Code: 470 (MS-DRG)
- CPT Billing Code: 470
- Insurance Median: $16,070
- Cash Discount Price: $33,027
- vs. Medicare Baseline: 1.14x Medicare
Average discount available for prompt cash payment at this facility.
Median negotiated contract rate across all mapped commercial carriers.
Standard federal government reimbursement rate for this code.
Visual Cost Comparison vs. 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.
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 | $9,928 - $16,070 | 71% |
| Medicaid / KanCare | $9,928 - $16,381 | 71% |
| Aetna | $9,928 - $16,191 | 71% |
| Blue Cross Blue Shield | $11,434 - $26,674 | 81% |
| Providrs Care Network Contracted [320484] | $15,045 | 107% |
| Kindful Hospice [20434] | $16,070 | 114% |
| Kindful Hospice Contracted [320434] | $16,070 | 114% |
| Pace Of The Ozarks Contracted [320518] | $16,070 | 114% |
| Medicare (plans) | $16,070 - $16,111 | 114% |
| Mercy Hospice Okc [20252] | $16,070 | 114% |
| American Health Advantage Of Ks Mcr Contracted [320508] | $16,070 | 114% |
| Elara Caring Aspire Hospice [20433] | $16,070 | 114% |
| Indian Health Service Contracted [320198] | $16,070 | 114% |
| Cross Timbers Hospice [20098] | $16,070 | 114% |
| Halo Hcr Inc Hospice [20432] | $16,070 | 114% |
| Halo Hcr Inc Hospice Contracted [320432] | $16,070 | 114% |
| Dept Of Veteran Affairs Contracted [320106] | $16,070 | 114% |
| Medica Contracted [320239] | $16,180 | 115% |
| UnitedHealthcare | $16,381 | 117% |
| Home State Health Plan Contracted [320187] | $16,381 | 117% |
| Ambetter / Centene | $16,381 | 117% |
| Tricare | $17,536 | 125% |
| Cigna | $19,760 - $22,975 | 141% |
| Health Choice Contracted [320166] | $24,941 | 178% |
Consumer Guidance & Cost Commentary
For a hip or knee replacement at Mercy Hospital Pittsburg, Inc., the cash price of $33,027 is significantly lower than the average negotiated rates paid by major insurers, which range from $9,928 to $24,941 depending on the plan. While many commercial payers like Humana, Aetna, and UnitedHealthcare negotiate rates between $9,928 and $16,381, patients with high-deductible plans may find paying cash upfront more cost-effective, as the cash price avoids the administrative markup often embedded in insurance contracts. It is important to note that while the facility's cash rate is competitive, the median negotiated amount of $16,070 reflects the contractual ceilings set by insurers, which can sometimes exceed the direct cash price for self-pay patients.
The facility's billing practices align with federal protections under the No Surprises Act, which prohibits balance billing for out-of-network services at in-network facilities, though patients should still request an itemized bill to verify all charges. Medicare serves as a reliable benchmark for pricing transparency, with the facility's allowed amount of $14,044 representing the federal cost baseline; commercial rates are often higher due to administrative overhead and contract dynamics. To minimize costs, patients should proactively ask about prompt-pay discounts, which can reduce bills by 20% to 50% for upfront payment, and ensure they receive a detailed, line-by-line statement rather than a summary invoice to identify any unbundled codes or services not rendered.