CMS Price Transparency Data
Hip or knee replacement (inpatient stay)
Facility: Mercy Hospital Springfield
Billing Code: 470 (MS-DRG)
Factual Cost Summary (Answer Capsule)
- CPT Billing Code: 470
- Insurance Median: $16,299
- Cash Discount Price: $29,570
- vs. Medicare Baseline: 1.16x Medicare
The contracted insurance negotiated median rate for a Hip or knee replacement (inpatient stay) at Mercy Hospital Springfield is $16,299. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $29,570. Compared to the federal Medicare reimbursement reference rate of $14,044.15, this hospital’s rate is 1.16x the Medicare baseline. Located in 2115 S. Fremont Ave, Springfield, MO.
Cash / Self-Pay
$29,570
Average discount available for prompt cash payment at this facility.
Insurance Median
$16,299
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: $29,570 (211%)
Insurance Median: $16,299 (116%)
Cash: $29,570 (211% of Medicare)
Ins. Median: $16,299 (116% 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 |
|---|---|---|
| Multiplan Contracted [320270] | $3,765 | 27% |
| Private Health Care Systems Contracted [320320] | $3,765 | 27% |
| UnitedHealthcare | $3,765 - $27,522 | 27% |
| Ambetter / Centene | $3,891 | 28% |
| Home State Health Plan Contracted [320187] | $3,891 | 28% |
| Medicaid / KanCare | $3,891 - $11,660 | 28% |
| Novasys Contracted [320285] | $3,891 | 28% |
| Aetna | $8,277 - $20,952 | 59% |
| Humana | $8,277 - $16,299 | 59% |
| Blue Cross Blue Shield | $11,434 - $19,885 | 81% |
| Point C Contracted [320238] | $13,771 - $18,520 | 98% |
| Evolutions Health Care Contracted [320124] | $14,399 | 103% |
| Providrs Care Network Contracted [320484] | $15,045 | 107% |
| Medical Destinations Contracted [320242] | $15,615 | 111% |
| Centivo Contracted [320505] | $15,822 | 113% |
| Centurion Of Missouri [20459] | $15,822 | 113% |
| Champva [20065] | $15,822 | 113% |
| Cherokee Nation Health Serv Contracted [320066] | $15,822 | 113% |
| Cigna | $15,822 - $22,975 | 113% |
| Cross Timbers Hospice [20098] | $15,822 | 113% |
| Dept Of Veteran Affairs Contracted [320106] | $15,822 | 113% |
| Elara Caring Aspire Hospice [20433] | $15,822 | 113% |
| Federal Medical Center Contracted [320127] | $15,822 | 113% |
| Globalhealth Contracted [320145] | $15,822 | 113% |
| Halo Hcr Inc Hospice Contracted [320432] | $15,822 | 113% |
| Halo Hcr Inc Hospice [20432] | $15,822 | 113% |
| Indian Health Service Contracted [320198] | $15,822 | 113% |
| Indian Health Service [20198] | $15,822 | 113% |
| Kindful Hospice Contracted [320434] | $15,822 | 113% |
| Kindful Hospice [20434] | $15,822 | 113% |
| Medicare (plans) | $15,822 - $16,313 | 113% |
| Mercy Hospice Okc [20252] | $15,822 | 113% |
| Mercy Mgd Behavioral Health Contracted [320259] | $15,822 | 113% |
| Mercy Rehab Hospital Contracted [320260] | $15,822 | 113% |
| Pace Of The Ozarks Contracted [320518] | $15,822 | 113% |
| Qual Choice Contracted [320325] | $15,822 | 113% |
| Mercy Benefit Admin Contracted [320251] | $16,054 - $17,815 | 114% |
| United Medical Resources Contracted [320454] | $16,606 - $20,388 | 118% |
| Benefit Management Contracted [320052] | $16,608 | 118% |
| 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% |
| Provider Partners Health Plans Contracted [320450] | $17,104 | 122% |
| Health Systems Inc Contracted [320174] | $17,105 | 122% |
| Insurance System Inc Contracted [320465] | $17,105 | 122% |
| Point C [20238] | $17,232 | 123% |
| Tricare | $17,536 | 125% |
| Medica Contracted [320239] | $17,648 | 126% |
| Medica [20239] | $17,648 | 126% |
| Healthscope Contracted [320182] | $19,477 | 139% |
| First Health Contracted [320128] | $20,589 | 147% |