CMS Price Transparency Data
Hip or knee replacement (inpatient stay)
Facility: Mercy Hospital St Louis
Billing Code: 470 (MS-DRG)
Factual Cost Summary (Answer Capsule)
- CPT Billing Code: 470
- Insurance Median: $15,263
- Cash Discount Price: $27,226
- vs. Medicare Baseline: 1.09x Medicare
The contracted insurance negotiated median rate for a Hip or knee replacement (inpatient stay) at Mercy Hospital St Louis is $15,263. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $27,226. Compared to the federal Medicare reimbursement reference rate of $14,044.15, this hospital’s rate is 1.09x the Medicare baseline. Located in 615 New Ballas Road, Saint Louis, MO.
Cash / Self-Pay
$27,226
Average discount available for prompt cash payment at this facility.
Insurance Median
$15,263
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: $27,226 (194%)
Insurance Median: $15,263 (109%)
Cash: $27,226 (194% of Medicare)
Ins. Median: $15,263 (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 | $3,478 | 25% |
| Home State Health Plan Contracted [320187] | $3,478 | 25% |
| Medicaid / KanCare | $3,478 - $3,731 | 25% |
| Novasys Contracted [320285] | $3,478 | 25% |
| Aetna | $3,731 - $24,217 | 27% |
| Cigna | $9,661 - $15,263 | 69% |
| Healthlink Contracted [320179] | $11,175 - $28,075 | 80% |
| Mercy Benefit Admin Contracted [320251] | $14,417 - $15,078 | 103% |
| Mercy Benefit Admin [20251] | $14,417 - $15,078 | 103% |
| Show-Me Health Administrators Contracted [320483] | $14,637 - $15,369 | 104% |
| Aither Health Contracted [320449] | $15,078 | 107% |
| Aither Health [20449] | $15,078 | 107% |
| Auxiant Contracted [320462] | $15,078 | 107% |
| Ebms Contracted [320493] | $15,078 | 107% |
| Edison Health Solutions Contracted [320502] | $15,078 | 107% |
| Imagine 360 Contracted [320494] | $15,078 | 107% |
| Reflect Health Contracted [320492] | $15,078 | 107% |
| Yuzu Health Contracted [320521] | $15,078 | 107% |
| American Health Advantage Of Mo Mcr [10473] | $15,263 | 109% |
| Blue Cross Blue Shield | $15,263 - $36,070 | 109% |
| Centivo Contracted [320505] | $15,263 | 109% |
| Cherokee Nation Health Serv Contracted [320066] | $15,263 | 109% |
| Cross Timbers Hospice [20098] | $15,263 | 109% |
| Dept Of Veteran Affairs Contracted [320106] | $15,263 | 109% |
| Elara Caring Aspire Hospice Contracted [320433] | $15,263 | 109% |
| Elara Caring Aspire Hospice [20433] | $15,263 | 109% |
| Globalhealth Contracted [320145] | $15,263 | 109% |
| Halo Hcr Inc Hospice Contracted [320432] | $15,263 | 109% |
| Halo Hcr Inc Hospice [20432] | $15,263 | 109% |
| Healthscope Contracted [320182] | $15,263 | 109% |
| Hope Trust Contracted [320488] | $15,263 | 109% |
| Humana | $15,263 | 109% |
| Indian Health Service Contracted [320198] | $15,263 | 109% |
| Kindful Hospice Contracted [320434] | $15,263 | 109% |
| Kindful Hospice [20434] | $15,263 | 109% |
| Medicare (plans) | $15,263 - $15,757 | 109% |
| Mercy Hospice Okc [20252] | $15,263 | 109% |
| Pace Of The Ozarks Contracted [320518] | $15,263 | 109% |
| Qual Choice Contracted [320325] | $15,263 | 109% |
| UnitedHealthcare | $15,263 - $24,786 | 109% |
| Medica Contracted [320239] | $16,421 | 117% |
| Provider Partners Health Plans Contracted [320450] | $17,363 | 124% |
| Tricare | $18,539 | 132% |
| United Medical Resources Contracted [320454] | $24,786 | 176% |
| Preferred Health Plan Contracted [320522] | $28,108 | 200% |
| First Health Contracted [320128] | $33,424 | 238% |
| Mercy Mgd Behavioral Health Contracted [320259] | $33,424 | 238% |
| Multiplan Contracted [320270] | $33,424 | 238% |
| Private Health Care Systems Contracted [320320] | $33,424 | 238% |