CMS Price Transparency Data

Hip or knee replacement (inpatient stay)

Facility: Mercy Hospital Lincoln

Billing Code: 470 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 470
Insurance Median: $2,550
Cash Discount Price: $29,519
vs. Medicare Baseline: 0.18x Medicare

The contracted insurance negotiated median rate for a Hip or knee replacement (inpatient stay) at Mercy Hospital Lincoln is $2,550. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $29,519. Compared to the federal Medicare reimbursement reference rate of $14,044.15, this hospital’s rate is 0.18x the Medicare baseline. Located in 1000 East Cherry Street, Troy, MO.

Cash / Self-Pay

$29,519

Average discount available for prompt cash payment at this facility.

Insurance Median

$2,550

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: $29,519 (210%)

Insurance Median: $2,550 (18%)

Cash: $29,519 (210% of Medicare)

Ins. Median: $2,550 (18% 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.

Billing Status

Remaining Deductible ($)

Your Coinsurance 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
Medicare (plans)	$2,426 - $3,020	17%
Aetna	$2,473	18%
American Health Advantage Of Mo Mcr [10473]	$2,550	18%
Blue Cross Blue Shield	$2,550 - $11,352	18%
Cherokee Nation Health Serv Contracted [320066]	$2,550	18%
Cross Timbers Hospice [20098]	$2,550	18%
Dept Of Veteran Affairs Contracted [320106]	$2,550	18%
Elara Caring Aspire Hospice Contracted [320433]	$2,550	18%
Elara Caring Aspire Hospice [20433]	$2,550	18%
Globalhealth Contracted [320145]	$2,550	18%
Halo Hcr Inc Hospice Contracted [320432]	$2,550	18%
Halo Hcr Inc Hospice [20432]	$2,550	18%
Humana	$2,550	18%
Indian Health Service Contracted [320198]	$2,550	18%
Kindful Hospice Contracted [320434]	$2,550	18%
Kindful Hospice [20434]	$2,550	18%
Mercy Hospice Okc [20252]	$2,550	18%
Pace Of The Ozarks Contracted [320518]	$2,550	18%
Qual Choice Contracted [320325]	$2,550	18%
UnitedHealthcare	$2,550 - $20,813	18%
Healthlink Contracted [320179]	$3,019 - $3,321	21%
Cigna	$3,020	22%
Provider Partners Health Plans Contracted [320450]	$3,322	24%
Centivo Contracted [320505]	$4,538	32%
Hope Trust Contracted [320488]	$5,292	38%
Ambetter / Centene	$5,480	39%
Home State Health Plan Contracted [320187]	$5,480	39%
Medicaid / KanCare	$5,480	39%
Novasys Contracted [320285]	$5,480	39%
United Medical Resources Contracted [320454]	$20,813	148%

Self-Pay Upfront Cash Action Plan

Request a "Self-Pay classification" with the billing desk before receiving care.
Ask for a written "Prompt-Pay Discount" agreement quoting the price of $29,519.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify MS-DRG Code matches exactly: 470.

Insurance In-Network Protection Plan

Contact your insurance company to confirm Mercy Hospital Lincoln is fully in-network.
Ask your insurer if "Prior Authorization" is required for MS-DRG code 470.
Confirm the specific physician or imaging center is also in-network (not just the hospital building).
Audit your Explanation of Benefits (EOB) against the final itemized hospital invoice.