CMS Price Transparency Data

Hip or knee replacement (inpatient stay)

Facility: Mercy St Vincent Medical Center

Billing Code: 470 (MS-DRG)

The BaseRate · fair price high confidence

A fair price for this

$15,228

about 1.1× the $14,044 Medicare rate · typically $11,227–$23,303

modeled estimate · not a bill or quote

What this hospital charges insurers

$15,972

About the fair price

about $744 over the fair price · 1.1× Medicare

Medicare pays $14,044 Fair price $15,228 This hospital $15,972

How we calculate the fair BaseRate →

How this hospital compares to other OH hospitals

Highest price of the 9 OH hospitals we have prices for — worth calling around.

Cheapest $8,680 Priciest $15,972

Black dot = this hospital, among the 9 OH hospitals with a price for this procedure. Full list below.

A fair price for a Hip or knee replacement (inpatient stay) is about $15,228 (about 1.1× the $14,044 Medicare rate). Mercy St Vincent Medical Center charges insurers about $15,972 — about the fair price. Located in Toledo, OH.

What each insurance company pays

Which insurers have negotiated a price with this hospital for this procedure — and which haven’t.

5 of 6 major insurers have a published price at this hospital

✓ UnitedHealthcare✓ Blue Cross Blue Shield✓ Aetna✓ Cigna✓ Humana Kaiser Permanente

Crossed out = this hospital hasn’t published a negotiated price for that insurer for this procedure. It doesn’t necessarily mean they aren’t accepted — ask your insurer.

Insurance company	Price range	vs. Medicare
UnitedHealthcaremajor	$5,538 - $54,006	39%
Blue Cross Blue Shieldmajor	$5,435 - $32,544	39%
Aetnamajor	$13,656 - $26,545	97%
Cignamajor	$28,436 - $36,183	202%
Humanamajor	$5,435 - $14,422	39%
AmeriHealth	$5,435 - $9,427	39%
CareSource	$5,357 - $24,007	38%
Devoted Health	$14,567 - $16,312	104%
Medical Mutual	$32,374	231%
Molina	$15,144 - $26,276	108%
Paramount	$13,642 - $14,422	97%
+ 4 smaller / regional plans	$5,383 - $25,663

Government programs also on file: Medicare, Medicaid.

Self-Pay How to get the cash price

Tell the billing desk you want to be billed as self-pay — not through insurance — before your visit.
Ask for the cash / prompt-pay discount in writing, with the exact price, before you agree to anything.
Get it in writing that they won’t also bill your insurance, so the cash price is what you owe.
Check the MS-DRG code on your bill matches exactly: 470.

Insurance Before you use insurance

Call your insurance company to confirm Mercy St Vincent Medical Center is in-network.
Ask your insurer whether prior approval is required for MS-DRG code 470.
Confirm the doctor or provider is in-network too — not just the hospital building.
Check your Explanation of Benefits against the hospital’s final itemized bill.

Estimate your out-of-pocket cost

A rough estimate of what you’d pay with insurance (deductible + coinsurance) versus paying the cash price yourself.

How you’d pay

Deductible left to meet ($)

Your coinsurance (%)

Enter your details and press estimate to compare.

Other Procedures at Mercy St Vincent Medical Center

Compare: Hip or knee replacement (inpatient stay) at other OH hospitals

Fulton County Health Center · Wauseon $8,680
Cincinnati Children's Hospital Medical Center · Cincinnati $8,848
Christ Hospital · Cincinnati $11,295
Medina Hospital · Medina $12,593
Bellevue Hospital · Bellevue $12,854
Lake Health Beachwood Medical Center · Beachwood $12,854
Cleveland Clinic Avon Hospital · Avon $12,968
Mh St Joseph Warren Hospital · Warren $13,079

Insurance negotiated median for the same procedure, sorted lowest first.