CMS Price Transparency Data

Hip or knee replacement (inpatient stay)

Facility: Mercy Hospital Carthage

Billing Code: 470 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 470
Insurance Median: $2,245
Cash Discount Price: $26,068
vs. Medicare Baseline: 0.16x Medicare

The contracted insurance negotiated median rate for a Hip or knee replacement (inpatient stay) at Mercy Hospital Carthage is $2,245. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $26,068. Compared to the federal Medicare reimbursement reference rate of $14,044.15, this hospital’s rate is 0.16x the Medicare baseline. Located in 3125 Dr Russell Smith Way, Carthage, MO.

Cash / Self-Pay

$26,068

Average discount available for prompt cash payment at this facility.

Insurance Median

$2,245

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: $26,068 (186%)

Insurance Median: $2,245 (16%)

Cash: $26,068 (186% of Medicare)

Ins. Median: $2,245 (16% 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
United Medical Resources Contracted [320454]	$1,835	13%
UnitedHealthcare	$1,835 - $10,163	13%
Aetna	$2,245 - $10,648	16%
Blue Cross Blue Shield	$2,245 - $20,821	16%
Cherokee Nation Health Serv Contracted [320066]	$2,245	16%
Cigna	$2,245	16%
Cross Timbers Hospice [20098]	$2,245	16%
Dept Of Veteran Affairs Contracted [320106]	$2,245	16%
Elara Caring Aspire Hospice [20433]	$2,245	16%
Globalhealth Contracted [320145]	$2,245	16%
Halo Hcr Inc Hospice Contracted [320432]	$2,245	16%
Halo Hcr Inc Hospice [20432]	$2,245	16%
Humana	$2,245 - $11,681	16%
Indian Health Service Contracted [320198]	$2,245	16%
Kindful Hospice Contracted [320434]	$2,245	16%
Kindful Hospice [20434]	$2,245	16%
Medical Associates Health Contracted [320444]	$2,245	16%
Medicare (plans)	$2,245 - $15,797	16%
Mercy Hospice Okc [20252]	$2,245	16%
Mercy Mgd Behavioral Health Contracted [320259]	$2,245	16%
Pace Of The Ozarks Contracted [320518]	$2,245	16%
Provider Partners Health Plans Contracted [320450]	$2,245	16%
Qual Choice Contracted [320325]	$2,245	16%
Healthscope Contracted [320182]	$4,622	33%
Ambetter / Centene	$5,737	41%
Home State Health Plan Contracted [320187]	$5,737	41%
Medicaid / KanCare	$5,737 - $11,660	41%
Novasys Contracted [320285]	$5,737	41%
Multiplan Contracted [320270]	$10,163	72%
Private Health Care Systems Contracted [320320]	$10,163	72%
Health Systems Inc Contracted [320174]	$12,331	88%
Insurance System Inc Contracted [320465]	$12,331	88%
Health Choice Contracted [320166]	$24,941	178%

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 $26,068.
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 Carthage 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.