CMS Price Transparency Data
Hip or knee replacement (inpatient stay)
Facility: Mercy Hospital Joplin
Billing Code: 470 (MS-DRG)
Factual Cost Summary (Answer Capsule)
- CPT Billing Code: 470
- Insurance Median: $15,322
- Cash Discount Price: $31,041
- vs. Medicare Baseline: 1.09x Medicare
The contracted insurance negotiated median rate for a Hip or knee replacement (inpatient stay) at Mercy Hospital Joplin is $15,322. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $31,041. Compared to the federal Medicare reimbursement reference rate of $14,044.15, this hospital’s rate is 1.09x the Medicare baseline. Located in 100 Mercy Way, Joplin, MO.
Cash / Self-Pay
$31,041
Average discount available for prompt cash payment at this facility.
Insurance Median
$15,322
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: $31,041 (221%)
Insurance Median: $15,322 (109%)
Cash: $31,041 (221% of Medicare)
Ins. Median: $15,322 (109% 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 |
|---|---|---|
| Ambetter / Centene | $2,728 | 19% |
| Home State Health Plan Contracted [320187] | $2,728 | 19% |
| Medicaid / KanCare | $2,728 - $15,322 | 19% |
| Novasys Contracted [320285] | $2,728 | 19% |
| Multiplan Contracted [320270] | $3,765 | 27% |
| Private Health Care Systems Contracted [320320] | $3,765 | 27% |
| Usable Contracted [320409] | $3,765 | 27% |
| Aetna | $8,277 - $15,322 | 59% |
| Humana | $8,277 - $14,571 | 59% |
| Indian Health Service Contracted [320198] | $10,858 - $15,322 | 77% |
| Blue Cross Blue Shield | $11,434 - $22,076 | 81% |
| Health Systems Inc Contracted [320174] | $12,331 | 88% |
| Insurance System Inc Contracted [320465] | $12,331 | 88% |
| Benefit Management Contracted [320052] | $13,192 | 94% |
| Providrs Care Network Contracted [320484] | $15,045 | 107% |
| Centivo Contracted [320505] | $15,322 | 109% |
| Champva [20065] | $15,322 | 109% |
| Cherokee Nation Health Serv Contracted [320066] | $15,322 | 109% |
| Cigna | $15,322 - $22,975 | 109% |
| Cross Timbers Hospice [20098] | $15,322 | 109% |
| Dept Of Veteran Affairs Contracted [320106] | $15,322 | 109% |
| Elara Caring Aspire Hospice [20433] | $15,322 | 109% |
| Globalhealth Contracted [320145] | $15,322 | 109% |
| Halo Hcr Inc Hospice Contracted [320432] | $15,322 | 109% |
| Halo Hcr Inc Hospice [20432] | $15,322 | 109% |
| Kindful Hospice Contracted [320434] | $15,322 | 109% |
| Kindful Hospice [20434] | $15,322 | 109% |
| Medicare (plans) | $15,322 - $15,797 | 109% |
| Mercy Hospice Okc [20252] | $15,322 | 109% |
| Mercy Mgd Behavioral Health Contracted [320259] | $15,322 | 109% |
| Pace Of The Ozarks Contracted [320518] | $15,322 | 109% |
| Provider Partners Health Plans Contracted [320450] | $15,322 | 109% |
| Qual Choice Contracted [320325] | $15,322 | 109% |
| UnitedHealthcare | $15,322 - $21,274 | 109% |
| First Health Contracted [320128] | $15,680 | 112% |
| Mercy Benefit Admin Contracted [320251] | $16,054 - $17,815 | 114% |
| Medica Contracted [320239] | $16,180 | 115% |
| Point C Contracted [320238] | $16,377 | 117% |
| 90 Degree Benefits Contracted [320436] | $16,967 | 121% |
| Show-Me Health Administrators Contracted [320483] | $16,967 - $17,815 | 121% |
| Aither Health Contracted [320449] | $17,032 | 121% |
| Auxiant Contracted [320462] | $17,032 | 121% |
| Ebms Contracted [320493] | $17,032 | 121% |
| Edison Health Solutions Contracted [320502] | $17,032 | 121% |
| Healthlink Contracted [320179] | $17,032 - $20,886 | 121% |
| Imagine 360 Contracted [320494] | $17,032 | 121% |
| Reflect Health Contracted [320492] | $17,032 | 121% |
| Yuzu Health Contracted [320521] | $17,032 | 121% |
| United Medical Resources Contracted [320454] | $17,435 - $21,274 | 124% |
| Tricare | $17,536 | 125% |
| Healthscope Contracted [320182] | $18,861 | 134% |
| Health Choice Contracted [320166] | $24,254 | 173% |