CMS Price Transparency Data

Hip or knee replacement (inpatient stay)

Facility: Mercy Health Saint Mary's

Billing Code: 470 (MS-DRG)

The BaseRate · fair price high confidence

A fair price for this

$18,912

about 1.3× the $14,044 Medicare rate · typically $15,215–$30,106

modeled estimate · not a bill or quote

What this hospital charges insurers

$31,784

Above the fair price

about $12,872 over the fair price · 2.3× Medicare

Medicare pays $14,044 Fair price $18,912 This hospital $31,784 Cash price $34,911

How we calculate the fair BaseRate →

How this hospital compares to other MI hospitals

Highest price of the 9 MI hospitals we have prices for — worth calling around.

Cheapest $7,442 Priciest $31,784

Black dot = this hospital, among the 9 MI hospitals with a price for this procedure. Full list below.

A fair price for a Hip or knee replacement (inpatient stay) is about $18,912 (about 1.3× the $14,044 Medicare rate). Mercy Health Saint Mary's charges insurers about $31,784, or about $34,911 in cash — above the fair price. Located in Grand Rapids, MI.

This price is above the fair BaseRate — you may be able to pay less

Ask the hospital for the cash / self-pay price, check whether you qualify for financial assistance, or negotiate the bill down toward the fair price of about $18,912. Many patients pay well below the first number they’re quoted — the checklists below walk you through it.

What each insurance company pays

Which insurers have negotiated a price with this hospital for this procedure — and which haven’t.

4 of 6 major insurers have a published price at this hospital

✓ UnitedHealthcare✓ Blue Cross Blue Shield✓ Aetna✓ Kaiser Permanente CignaHumana

Crossed out = this hospital hasn’t published a negotiated price for that insurer for this procedure. It doesn’t necessarily mean they aren’t accepted — ask your insurer.

Insurance company	Price range	vs. Medicare
UnitedHealthcaremajor	$16,058	114%
Blue Cross Blue Shieldmajor	$15,278 - $42,165	109%
Aetnamajor	$15,278 - $31,784	109%
Kaiser Permanentemajor	$42,165	300%
CareSource	$21,916	156%
GEHA	$31,784	226%
Medical Mutual	$31,784	226%
Molina	$20,267	144%
Oscar Health	$17,825	127%
Priority Health	$30,153 - $30,203	215%
+ 12 smaller / regional plans	$2,000 - $42,165

Government programs also on file: Medicare.

Excludes 1 rental-network / third-party entry (e.g. Multiplan, PHCS) — these are pricing networks, not insurers.

Self-Pay How to get the cash price

Tell the billing desk you want to be billed as self-pay — not through insurance — before your visit.
Ask for the cash / prompt-pay discount in writing, with the exact price (about 34,911), before you agree to anything.
Get it in writing that they won’t also bill your insurance, so the cash price is what you owe.
Check the MS-DRG code on your bill matches exactly: 470.

Insurance Before you use insurance

Call your insurance company to confirm Mercy Health Saint Mary's is in-network.
Ask your insurer whether prior approval is required for MS-DRG code 470.
Confirm the doctor or provider is in-network too — not just the hospital building.
Check your Explanation of Benefits against the hospital’s final itemized bill.

Estimate your out-of-pocket cost

A rough estimate of what you’d pay with insurance (deductible + coinsurance) versus paying the cash price yourself.

How you’d pay

Deductible left to meet ($)

Your coinsurance (%)

Enter your details and press estimate to compare.

Other Procedures at Mercy Health Saint Mary's

Compare: Hip or knee replacement (inpatient stay) at other MI hospitals

Insurance negotiated median for the same procedure, sorted lowest first.